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Melamine-related kidney stones and renal toxicity

Nature Reviews Nephrology volume 7, pages 267–274 (2011)Cite this article

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Abstract

Several well-documented outbreaks of melamine poisoning have occurred in both animals and humans during the past 7 years, which led to the identification of melamine and cyanuric acid as nephrotoxins. This Review provides an overview of the known experimental and observational data (including toxicology, epidemiology, and pathology) concerning melamine contamination of foodstuffs, both alone and in combination with cyanuric acid. The various renal effects of ingestion of these compounds in both animals and humans are described, and a hypothesis on the mechanism of formation of melamine-based kidney stones is presented. Finally, the public health measures taken in the wake of the melamine contamination events are discussed.

Key Points

  • Melamine has been used to adulterate animal and human foodstuffs owing to its high nitrogen content, which gives false results in nitrogen-based assays for measuring the protein content of food

  • Ingestion of melamine leads to primarily renal toxic effects; their severity depends on whether a related compound, cyanuric acid, is also present

  • Melamine ingestion in human infants is associated with retrograde nephropathy owing to melamine precipitation in the lower urinary tract and formation of melamine–uric acid stones, but low mortality

  • The toxic effects of melamine ingestion in animals are consistent with combined melamine and cyanuric acid ingestion, leading to high mortality and formation of melamine–cyanuric acid stones

  • Management of patients with melamine–uric acid stones is largely conservative, consisting of withholding suspect foodstuffs, hydration, and urinary alkalinization

  • Most 'sand-gravel-like' melamine–uric acid stones (∼80%) are expelled within days, but 'lump-like' stones (∼20%) in infants can require invasive treatment, including renal replacement therapy

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Figure 1: The crystal structure of melamine–cyanuric acid.
Figure 2: Predicted crystal structure of melamine–uric acid.

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Author information

Authors and Affiliations

  1. Department of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, 10016, NY, USA

    Rishikesh P. Dalal

  2. New York Harbor Veterans Affairs Medical Center, 423 East 23rd Street, New York, 10010, NY, USA

    David S. Goldfarb

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R. P. Dalal researched the data for the article, wrote the manuscript, and provided substantial contributions to discussions of the article's content, and to reviewing and editing of the manuscript before submission. D. S. Goldfarb provided substantial contributions to discussions of the article's content and to reviewing and editing of the manuscript before submission.

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Correspondence to David S. Goldfarb.

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Dalal, R., Goldfarb, D. Melamine-related kidney stones and renal toxicity. Nat Rev Nephrol 7, 267–274 (2011). https://doi.org/10.1038/nrneph.2011.24

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