Hypertonic saline-induced urolithiasis presenting as acute renal failure in a child with traumatic brain injury: A case report

We report the case of a 4 year old female with severe traumatic brain injury who developed bilateral obstructing ureteral stones after hypertonic saline treatment. She developed calcium phosphate stones after two weeks of hypertonic saline therapy, and was successfully treated with ureteral stents and ureteroscopy. She has remained stone-free since that time. We postulate that an incomplete type 1 renal tubular acidosis made her intolerant to the acid and sodium load of the saline, and discuss other lithogenic factors of her presentation.