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Low Risk for Kidney Problems from Low-Dose Melamine Exposure

The results of a large screening program suggest that population screening for kidney disease after low-dose melamine exposure is unwarranted.

Concern about kidney complications in children who were exposed to melamine-contaminated milk has prompted calls for widespread screening of exposed children. The Hong Kong government undertook a screening program and reports the results for 3170 children (age, <12 years) who were exposed to melamine-contaminated milk daily for at least 1 month. Screening involved renal ultrasound, urinalysis, and blood tests.

One child had a nonobstructing renal stone, and seven children had hyperechogenic deposits near the renal papillae. The estimated melamine intake from milk for these eight children was 0.10 to 0.21 mg/kg/day (below the estimated tolerable daily intake of 0.63 mg/kg/day; World Health Organization). One child with papillary deposits had urinary frequency and dysuria. Testing by urine dipsticks indicated that 208 children (8% of girls and 5% of boys) had positive results for hemoglobin, but only 4 children had red blood cells confirmed by microscopy. Urine calcium-to-creatinine ratios and serum creatinine values were normal in all children with renal stones or deposits. No case of renal failure was detected.

Comment: The melamine content of contaminated milk in Hong Kong was estimated to be only 2.5% of the maximum melamine content of contaminated milk in mainland China. The results of this large screening program suggest that population screening for kidney disease after low-dose melamine exposure is unwarranted. These findings support the recommendations of the American Society of Pediatric Nephrology.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 14, 2009

Citation(s):

Lam HS et al. Renal screening in children after exposure to low dose melamine in Hong Kong: Cross sectional study. BMJ 2008 Dec 18; 337:a2991. (http://dx.doi.org/10.1136/bmj.a2991)

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