Q: My granddaughter will be three next month. She has salt wasting CAH and was born with ambiguous genitalia. She has developed massive amounts of calcium in the tissue of both kidneys, and her kidneys are not growing based on the last ultra sound. Is this a normal occurrence with CAH? Does the cortef or florinef cause this condition? We were told she will need a kidney transplant at some point. She is also on blood pressure medication due to thinning cortex. Lastly, my granddaughter has yellowing of the teeth and she thinks it may be caused by the medication.
Any information will be helpful.

A: Nephrocalcinosis (excessive calcium in the kidney) can be caused by conditions where there is too much aldosterone or when a patient is being treated with too much Florinef (fludrocortisone), which is used to replace aldosterone in patients with salt-wasting CAH. If your granddaughter is hypertensive, that is another indication that she may be receiving too much Florinef. There is always the possibility that she has another underlying condition apart from her CAH that is causing the nephrocalcinosis, but it would be a good idea to make sure that her labs do not indicate that she is receiving too much Florinef. Laboratory indicators of too much Florinef would be a very suppressed (undetectable) plasma renin activity or a low potassium level.

Discoloration of the teeth may arise from some antibiotics (such as tetracycline or doxycycline). You mentioned that your granddaughter is taking medication to lower her blood pressure. Some anti-hypertensive medications may also cause discoloration. I am not aware of any relation between hydrocortisone or fludrocortisone and discoloration of the teeth.