Potassium Chromate as The Primary Constituent of Renal Stones in a Child With Chronic Chromium Ingestion: The First Case Report of Chromate Urolithiasis

Abstract

Background Paediatric urolithiasis is increasingly recognised and involves significant morbidity to patients. Most of the renal stones are either calcareous, consisting of oxalate, calcium phosphate or both but stones with potassium chromate as the primary constituent were never reported in literature. Case presentation A nine-year-old girl presented with a passing couple of stones per day in her urine for the preceding twelve days, without any other urinary symptoms. Her initial serum and urine biochemical investigations were within reference range. Abdominal imaging did not reveal any significant structural abnormalities. A macroscopic assessment of her stones revealed a rare reddish-orange colour. Stone analysis by Fourier transform-infrared spectroscope revealed potassium chromate as the main component of her stone. On further questioning, the patient’s mother revealed that the child was treated with an Ayurvedic medicine named ‘Thalisadhi Chooranam’ which was prescribed for bronchial asthma for six years. Analysis of the Ayurveda medicine revealed the presence of Chromium in it. She was kept under observation with sufficient hydration. Now the child is well without any complaints to date and the passage of stones has settled spontaneously. Conclusion This case highlights the fact that chronic oral chromium ingestion can lead to urolithiasis, in the absence of other systemic involvement of chromium toxicity. So care must be taken when prescribing the drugs that have chromium more specifically in the context of alternative medicines and prescriptions for children.