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Guleray Lafci N, van Goor M, Cetinkaya S, van der Wijst J, Acun M, Kurt Colak F, Cetinkaya A, Hoenderop J. Decreased calcium permeability caused by biallelic TRPV5 mutation leads to autosomal recessive renal calcium-wasting hypercalciuria. Eur J Hum Genet 2024:10.1038/s41431-024-01589-9. [PMID: 38528055 DOI: 10.1038/s41431-024-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
Hypercalciuria is the most common metabolic risk factor in people with kidney stone disease. Its etiology is mostly multifactorial, although monogenetic causes of hypercalciuria have also been described. Despite the increased availability of genetic diagnostic tests, the vast majority of individuals with familial hypercalciuria remain unsolved. In this study, we investigated a consanguineous pedigree with idiopathic hypercalciuria. The proband additionally exhibited severe skeletal deformities and hyperparathyroidism. Whole-exome sequencing of the proband revealed a homozygous ultra-rare variant in TRPV5 (NM_019841.7:c.1792G>A; p.(Val598Met)), which encodes for a renal Ca2+-selective ion channel. The variant segregates with the three individuals with hypercalciuria. The skeletal phenotype unique to the proband was due to an additional pathogenic somatic mutation in GNAS (NM_000516.7:c.601C>T; p.(Arg201Cys)), which leads to polyostotic fibrous dysplasia. The variant in TRPV5 is located in the TRP helix, a characteristic amphipathic helix that is indispensable for the gating movements of TRP channels. Biochemical characterization of the TRPV5 p.(Val598Met) channel revealed a complete loss of Ca2+ transport capability. This defect is caused by reduced expression of the mutant channel, due to misfolding and preferential targeting to the proteasome for degradation. Based on these findings, we conclude that biallelic loss of TRPV5 function causes a novel form of monogenic autosomal recessive hypercalciuria, which we name renal Ca2+-wasting hypercalciuria (RCWH). The recessive inheritance pattern explains the rarity of RCWH and underscores the potential prevalence of RCWH in highly consanguineous populations, emphasizing the importance of exploration of this disorder within such communities.
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Affiliation(s)
- Naz Guleray Lafci
- Hacettepe University, Medical Faculty, Department of Medical Genetics, Ankara, Turkey
- Health Science University, Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Medical Genetics, Ankara, Turkey
| | - Mark van Goor
- Department of Medical Biosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Semra Cetinkaya
- Health Science University, Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Jenny van der Wijst
- Department of Medical Biosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Melisa Acun
- Hacettepe University, Institute of Health Sciences, Department of Bioinformatics, Ankara, Turkey
| | - Fatma Kurt Colak
- Health Science University, Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Medical Genetics, Ankara, Turkey
| | - Arda Cetinkaya
- Hacettepe University, Medical Faculty, Department of Medical Genetics, Ankara, Turkey.
- Hacettepe University, Institute of Health Sciences, Department of Bioinformatics, Ankara, Turkey.
| | - Joost Hoenderop
- Department of Medical Biosciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Güzin Y, Yılmaz Ü, Devrim F, Dinçel N, Ünalp A. Kidney Stones in Epileptic Children Receiving Ketogenic Diet: Frequency and Risk Factors. Neuropediatrics 2023; 54:308-314. [PMID: 37257495 DOI: 10.1055/s-0043-1768987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although it is a valuable option for children with drug-resistant epilepsy, ketogenic diet (KD) therapy is associated with several side effects. The frequency of kidney stones and risk factors for their development in epileptic children receiving KD is unclear. The aim of this study was to determine the frequency and risk factors for the development of renal stones in children receiving KD therapy. METHODS A total of 95 patients receiving KD were identified. Of these, seven patients were excluded from the study due to the duration of KD being less than 12 months. The remaining 88 children were enrolled in the study. RESULTS Renal stones were detected in 15 patients (17%), of which 12 (73.3%) received potassium citrate treatment. Two (13.3%) patients needed lithotripsy despite receiving potassium citrate treatment, and one of these, who received potassium citrate treatment for 5 months, developed acute vesicourethral reflux and underwent surgery. No patient discontinued KD due to renal stone development. The serum uric acid concentrations and urine calcium/creatinine ratio did not change significantly over the 24-month follow-up period. Age, gender, etiology, age at seizure onset, duration of KD, mobility status, use of topiramate or zonisamide, and the number of antiepileptic drugs used were not significantly different between patients with and without kidney stones. CONCLUSION Renal stone appears to be a common adverse effect of KD therapy. Although adequate hydration and potassium citrate treatment are effective in most patients, lithotripsy and surgery may be required in a minority of patients.
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Affiliation(s)
- Yiğithan Güzin
- Department of Pediatric Neurology, University of Health Sciences Tepecik, Training and Research Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Department of Pediatric Neurology, Dr. Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatma Devrim
- Department of Pediatric Nephrology, University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Nida Dinçel
- Department of Pediatric Nephrology, University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Dr. Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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Marcellino A, Bloise S, Fraternali R, Pirone C, Brandino G, Testa A, Filippi L, Lubrano R. Evaluation of renal function and scars in children with primary vesicoureteral reflux. Urology 2022; 168:195-200. [PMID: 35780944 DOI: 10.1016/j.urology.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate growth, glomerular and tubular function, renal damage, scars in children affected by primary VUR. METHOD We retrospectively evaluated the clinical records of our Unit from January 2006 to September 2020. For each patient we evaluated growth, laboratoristic and scintigraphic glomerular and tubular function, renal damage and collective system urodynamics at baseline and at the last visit. RESULT We enrolled 41 patients affected by primary VUR and treated with continuous antibiotic prophylaxis. Glomerular function and urodynamics did not change over time. EFNa directly correlated with weight (r 0.44 p 0.004) and TRP inversely correlated with severity of reflux (r -0.32, p 0.04). Female sex was associated to nephrolithiasis (OR 17.0, p 0.02) and proteinuria (at T0 OR 5.8 p 0.03 at T1 OR 5.8, p 0.03). Daily proteinuria increased with age (r 0.66, p <0.0001 at T0 and r 0.44 p 0.004 at T1) while protein-to-creatinine ratio decreased. Renal scars at T0 inversely correlated with glomerular and tubular function at T1 but they did not correlate with severity or laterality of reflux. CONCLUSION Even if renal function remains stable through years, it is critical to identify the subjects with significant congenital renal damage.
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Affiliation(s)
- Alessia Marcellino
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Silvia Bloise
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Roberta Fraternali
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Carmelo Pirone
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giulia Brandino
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Alessia Testa
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Riccardo Lubrano
- Pediatrics and Neonatology Unit, Maternal-Child Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy.
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Saneian H, Esteki B, Bozorgzad M, Famouri F, Mehrkash M, Khademian M, Nasri P. Hyperuricosuria and hypercalciuria, probable etiologies of functional abdominal pain: A case-control study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:4. [PMID: 35342445 PMCID: PMC8943580 DOI: 10.4103/jrms.jrms_424_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/12/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Functional abdominal pain (FAP) is a common complaint causing several referrals to pediatricians. On the other hand, the most common presentation of hyperuricosuria and also hypercalciuria is chronic/recurrent abdominal pain. Therefore, a hypothesis has been raised; abdominal pain due to hyperuricosuria and/or hypercalciuria may be misdiagnosed as FAP. The current study has aimed to respond to this theory. MATERIALS AND METHODS This is a case-control study conducted on children diagnosed with FAP based on Rome IV criteria and age-matched normal controls. Blood and random urine samples were taken from healthy children and those with FAP. Random urine samples were examined for calcium, uric acid, oxalate, and creatinine concentrations. Random urine calcium to urine creatinine above 0.2 mg/mg was considered hypercalciuria and random urine uric acid above 0.56 mg/dl, GFR as hyperuricosuria. The data were analyzed using logistic models. RESULTS Hypercalciuric children had a significantly lower chance of FAP (odds ratio [OR] =0.425, 95% confidence interval [CI] =0.204-0.886). Although an inverse association was seen between hyperuricosuria and FAP (OR = 0.693, 95% CI = 0.395-1.214), it was not statistically significant. In stratified analyses by gender for both hyperuricosuria and hypercalciuria, a marginal inverse significant association was seen in male gender (P < 0.1). CONCLUSION Our study showed that hypercalciuria is significantly in inverse association with FAP but not hyperuricosuria. Therefore, these disorders, particularly hyperuricosuria may not be considered as the possible causes of FAP. Further studies with larger sample size for providing more reliable evidence are recommended.
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Affiliation(s)
- Hossein Saneian
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behnoosh Esteki
- Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Bozorgzad
- Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Famouri
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehryar Mehrkash
- Department of Pediatric Nephrology, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khademian
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peiman Nasri
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
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Guz Mark A, Levi S, Davidovits M, Marderfeld L, Shamir R. Children with Intestinal Failure Maintain Their Renal Function on Long-Term Parenteral Nutrition. Nutrients 2021; 13:3647. [PMID: 34684647 PMCID: PMC8539167 DOI: 10.3390/nu13103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long-term parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis, proteinuria and reduced glomerular filtration rate (GFR). Pediatric data are scarce and mostly short-term. Our study aimed to evaluate renal complications in children with intestinal failure (IF) receiving long-term PN. METHODS A cross-sectional study was performed in a tertiary pediatric IF clinic of patients receiving home-PN treatment for more than 1 year. Data regarding medical background, anthropometrics, laboratory investigations and abdominal sonography were retrieved. RESULTS Complete data were available for 15 children (67% males), with a median age of 6 (range 1.5-15) years and a median (IQR) PN duration of 4 (1.5-6) years. Low-grade proteinuria was identified in 61% and microalbuminuria in 30% of the cohort. Hypercalciuria and hyperoxaluria were present in 50% and 46%, respectively. One patient had nephrocalcinosis. The estimated GFR was normal in all but one patient who had pre-existing kidney disease. CONCLUSIONS Pediatric IF patients can present with preserved kidney function after years of PN treatment. Despite the high prevalence of hypercalciuria, nephrocalcinosis was not common. Base line and long-term monitoring of various aspects of renal function would be essential to characterize the effects of prolonged PN on kidney functions in pediatric patients.
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Affiliation(s)
- Anat Guz Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel; (L.M.); (R.S.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (S.L.); (M.D.)
| | - Shelly Levi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (S.L.); (M.D.)
- Institute of Pediatric Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Miriam Davidovits
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (S.L.); (M.D.)
- Institute of Pediatric Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Luba Marderfeld
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel; (L.M.); (R.S.)
- Nutrition and Dietetics Department, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel; (L.M.); (R.S.)
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (S.L.); (M.D.)
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Arman Bilir Ö, Kirkiz S, Fettah A, Ok Bozkaya İ, Kara A, Çakar N, Yaralı N. Renal function and the oxidative status among children with thalassemia major and healthy controls: A cross-sectional study. Transfus Apher Sci 2020; 59:102746. [PMID: 32173278 DOI: 10.1016/j.transci.2020.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/09/2020] [Accepted: 02/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Renal dysfunction is an underestimated complication of thalassemia major. OBJECTIVES The aim of this study is to compare the glomerular and tubular functions in children with β- Thalassemia major (β- TM) with healthy controls and assess the oxidative stress caused by high ferritin levels. DESIGN AND SETTING This prospective cross-sectional study was conducted in tertiary care hospital. METHODS Complete blood count (CBC), calcium (Ca), urea, creatinine (Cr), serum cystatin C before transfusion and urinary calcium (uCa), creatinine (uCr), protein (UPr) levels were analyzed in fresh samples. Beta-2-microglobulin (uβ2-MG), N- acetylglucosaminidase (uNAG), retinol binding protein (uRBP), malonedialdehyde (uMDA) secretion and creatinine levels were analyzed. Serum total antioxidant capacity (sTAC) and total oxidant capacity (sTOC) were measured with colorimetric micro-ELISA method. Last four serum ferritin values were recorded and the mean value was used for statistical analyzes. RESULTS Data from 47 patients and 32 controls were analyzed. The urinary RBP/Cr, Ca/Cr and Protein/Cr, were significantly higher in β-TM group. A statistically insignificant increase in urinary β2MG/Cr, uNAG/Cr, MDA/Cr was also found in the TM group. Proteinuria was present in 46 % (n: 22) and hypercalciuria in 34 % (n: 16) of the patients with β- TM. Serum total antioxidant capacity and total oxidant status (TOS) levels were significantly elevated in the patient group. Serum ferritin was significantly correlated with proteinuria, cystatin C levels, urinary Protein/Cr and uRBP/Cr. CONCLUSION Asymptomatic renal dysfunction is prevalent in β- TM patients that necessitate regular screening. Urinary RBP may be useful for early diagnosis.
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Affiliation(s)
- Özlem Arman Bilir
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Serap Kirkiz
- Department of Pediatric Hematology and Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ali Fettah
- Department of Pediatric Hematology and Oncology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Abdurrahman Kara
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology and Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Ellison JS, Hollingsworth JM, Langman CB, Asplin JR, Schwaderer AL, Yan P, Bierlein M, Barraza MA, Defoor WR, Figueroa TE, Jackson EC, Jayanthi VR, Johnson EK, Joseph DB, Shnorhavorian M. Analyte variations in consecutive 24-hour urine collections in children. J Pediatr Urol 2017; 13:632.e1-632.e7. [PMID: 28739373 DOI: 10.1016/j.jpurol.2017.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The metabolic evaluation of children with nephrolithiasis begins with a 24-h urine collection. For adults, the diagnostic yield increases with consecutive collections; however, little is known regarding the variability of multiple 24-h studies in the pediatric population. We sought to evaluate the variability of consecutive 24-h urine collection in children through a multi-institutional study hypothesizing that compared with a single collection, consecutive 24-h urine collections would reveal a greater degree of clinically useful information in the evaluation of children at risk for nephrolithiasis. MATERIALS AND METHODS Including data from six institutions, we identified children less than 18 years of age considered at risk for recurrent nephrolithiasis, undergoing metabolic evaluation. We evaluated a subset of patients performing two collections with urine creatinine varying by 10% or less during a 7-day period. Discordance between repeat collections based on normative urine chemistry values was evaluated. RESULTS A total of 733 children met inclusion criteria, and in over a third both urine calcium and urine volume differed by 30% or more between samples. Urine oxalate demonstrated greater variation between collections in children <5 years than among older children (p = 0.030) while variation in other parameters did not differ by age. Discordance between repeat samples based on normative values was most common for urine oxalate (22.5%) and the derived relative supersaturation ratios for both calcium phosphate (25.1%) and calcium oxalate (20.5%). The proportion of discordant samples, based on normative thresholds, as well as variability greater ≥30% and 50%, respectively, are shown in the table. CONCLUSIONS Our analysis indicates that stone risk in as many as one in four children may be misclassified if normative values of only a single 24-h urine are used. In light of these findings, repeat 24-h urine collections prior to targeted intervention to modify stone risk are advised to increase diagnostic yield in children at risk for nephrolithiasis.
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Affiliation(s)
| | | | - Craig B Langman
- Feinberg School of Medicine, Northwestern University and the Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John R Asplin
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, IL, USA
| | | | - Phyllis Yan
- Department of Urology, University of Michigan Medical School, MI, USA
| | - Maggie Bierlein
- Department of Urology, University of Michigan Medical School, MI, USA
| | | | - William R Defoor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Emilie K Johnson
- Feinberg School of Medicine, Northwestern University and the Lurie Children's Hospital of Chicago, Chicago, IL, USA
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The Modern Metabolic Stone Evaluation in Children. Urology 2016; 101:15-20. [PMID: 27838366 DOI: 10.1016/j.urology.2016.09.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate metabolic abnormalities in a contemporary pediatric population after their first stone episode. The incidence of pediatric nephrolithiasis is increasing and therefore the etiologies contributing to today's pediatric stone formation may also be changing. MATERIALS AND METHODS A retrospective review of all consecutive children presenting after their first kidney stone between 2000 and 2014 was performed. We compared demographic data, serum chemistry results, and 24-hour urine results and treatments. RESULTS One hundred thirteen children with a mean age of 11 years (5 months to 18 years) who presented with their first kidney stone episode between 2000 and 2014 were evaluated. Sixteen patients (14%) were found to have an underlying genetic or systemic disease. Overall, there was a low rate of serum chemistry abnormalities. The most common abnormalities found within the 24-hour urine evaluation included low urine volume (89%) and hypocitraturia (68%). Hypercalciuria occurred rarely (11%). CONCLUSION We identified a low rate of underlying genetic or systemic diseases contributing to modern pediatric stone presentation and an increased proportion of idiopathic stones. Our study differs from historical findings by identifying a low rate of hypercalciuria and a high rate of low urine volume and hypocitraturia, suggestive of changing metabolic abnormalities contributing to modern pediatric stone disease.
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Miyai K, Onishi T, Kashimada K, Hasegawa Y. Urinary calcium to creatinine ratio: a potential marker of secondary hyperparathyroidism in patients with vitamin D-dependent rickets type 1A. Endocr J 2015; 62:61-8. [PMID: 25284246 DOI: 10.1507/endocrj.ej14-0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with vitamin D-dependent rickets type 1A (VDDR1A) are usually treated with alfacalcidol, an analog of vitamin D. Around puberty, an increased dose of alfacalcidol is recommended for these patients to avoid hypocalcemia and secondary hyperparathyroidism. However, no indicators of secondary hyperparathyroidism except for PTH are presently known. The aim of this study is to evaluate whether urinary calcium to creatinine ratio (U-Ca/Cr) is useful as a biomarker of secondary hyperparathyroidism in VDDR1A patients in order to determine the proper dose of alfacalcidol. Two brothers with VDDR1A were recruited who had null mutations of CYP27B1 which encodes 1-alpha-hydroxylase of vitamin D. We investigated the relationship between U-Ca/Cr and intact-PTH around puberty when the brothers showed hypocalcemia with secondary hyperparathyroidism. The results were compared to those of five patients with vitamin D deficiency (VDD). As a result, high intact-PTH levels were observed when U-Ca/Cr decreased to less than 0.1 (mg/mg) in both VDDR1A brothers. This relationship was also observed in the VDD patients. However, it is necessary to take into account body calcium status, either in depletion or in excess, to accurately evaluate the relationship between U-Ca/Cr and secondary hyperparathyroidism. First, low U-Ca/Cr was detected in situations with calcium depletion without hyperparathyroidism in the VDDR1A patients. Second, high U-Ca/Cr with hyperparathyroidism could be detected theoretically in a condition of excess calcium supply. In conclusion, a U-Ca/Cr ratio of less than 0.1 (mg/mg) in VDDR1A patients is useful to accurately evaluate calcium depletion and secondary hyperparathyroidism.
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Affiliation(s)
- Kentaro Miyai
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan; Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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Urinary excretion of calcium, magnesium, phosphate, citrate, oxalate, and uric acid by healthy schoolchildren using a 12-h collection protocol. Pediatr Nephrol 2014; 29:1201-8. [PMID: 24519097 DOI: 10.1007/s00467-014-2755-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/10/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Improving knowledge about normal urine composition in children is important for early prevention of lithiasis. We describe urinary excretion values of calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) in healthy children with and without a family history of lithiasis, using a 12-h urine collection protocol. METHODS Urine samples were obtained from 184 children (5-12 years): a spot sample collected in the afternoon, and a 12-h overnight sample. Solute/creatinine (Cr) and 12-h solute excretion was calculated. RESULTS Urinary excretion values of the studied solutes are presented as percentile values, separately for each type of sample. Due to age-related differences in the solute/creatinine ratios, except for Ca and Cit, results are described according to the child's age. The presence of excretion values related to an increased risk of lithiasis was more common in children with a family history. CONCLUSIONS We report data from urine samples collected by using a simplified collection protocol. The observed differences between children with and without a family history of lithiasis could justify that in population studies aimed at setting reference values, the former are excluded.
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Jou YC, Tsai YS, Hsieh HY, Shen CH, Fang CY, Chen SY, Lin MF, Chen FH, Hsu CD. Age-dependent Association Between Dickkopf-1 and Calcium-containing Urolithiasis. Urology 2014; 83:1006-10. [DOI: 10.1016/j.urology.2013.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/03/2013] [Accepted: 12/13/2013] [Indexed: 12/17/2022]
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Akın Y, Uçar M, Yücel S. Current medical treatment in pediatric urolithiasis. Turk J Urol 2013; 39:253-63. [PMID: 26328120 DOI: 10.5152/tud.2013.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/30/2013] [Indexed: 11/22/2022]
Abstract
Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range from 6.5-54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kidney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recurrence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of the urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.
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Affiliation(s)
- Yiğit Akın
- Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Murat Uçar
- Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Selçuk Yücel
- Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Aguilera-Barreiro MDLA, Rivera-Márquez JA, Trujillo-Arriaga HM, Tamayo Y Orozco JA, Barreira-Mercado E, Rodríguez-García ME. Intake of dehydrated nopal (Opuntia ficus indica) improves bone mineral density and calciuria in adult Mexican women. Food Nutr Res 2013; 57:19106. [PMID: 23704856 PMCID: PMC3661902 DOI: 10.3402/fnr.v57i0.19106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 04/02/2013] [Accepted: 04/17/2013] [Indexed: 11/14/2022] Open
Abstract
Background The intake of dehydrated nopal (DN) at a high stage of maturity along with high calcium content could improve bone mineral density (BMD) and calciuria and thus prevent osteoporosis. Objective To evaluate the effect of calcium intake from a vegetable source (DN) on BMD and calciuria covering a 2-year period in menopausal and non-menopausal women with low bone mass (LBM). Methods The study was quasi-experimental, blinded, and randomized, and included 131 Mexican women aged 35–55. Urinary calcium/creatinine index (CCI) was determined; BMD was analyzed on lumbar spine and total hip regions. Four groups were studied: Control group (CG), women with normocalciuria and a minimum dose of DN; experimental group 1 (EG1), women with hypercalciuria and a minimum dose of DN; experimental group 2 (EG2), women with hypercalciuria, and a maximum dose of DN; and normal group (NG) for reference in BMD. Results After the first semester of treatment, calciuria levels in women from both experimental groups returned to normal, remaining constant for the rest of the treatment. The percentage difference in BMD increased in the total hip region in the CG (pre 4.5% and post 2.1%) and EG2 (pre 1.8% and post 2.5%) groups significantly in comparison to NG and EG1, which exhibited a significant decrease in their BMD. BMD increased only for the lumbar region in the EG2 group (premenopausal). Conclusion The use of a vegetable calcium source such as nopal improves BMD in women with LBM in the total hip and lumbar spine regions principally in the premenopausal women, maintaining constant and normal calciuria levels.
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Affiliation(s)
- María de Los Angeles Aguilera-Barreiro
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Delegación Coyoacán, D.F., México ; Facultad de Ciencias Naturales, Licenciatura en Nutrición, Universidad Autónoma de Querétaro, Juriquilla, Qro., México
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Nacaroglu HT, Demircin G, Bülbül M, Erdogan O, Akyüz SG, Caltik A. The association between urinary tract infection and idiopathic hypercalciuria in children. Ren Fail 2013; 35:327-32. [PMID: 23394064 DOI: 10.3109/0886022x.2013.764254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying the risk factors is important in prevention of urinary tract infections (UTIs) in children. The aim of this study is to evaluate the association of UTI and idiopathic hypercalciuria (IHC). METHODS Two hundred and twenty-four children aged between 1 month and 16 years and diagnosed to have UTI were evaluated for urinary calcium excretion. The children were diagnosed to have IHC if their urinary calcium/creatinine ratios in at least two different spot urine samples were >0.6 between 0-1 year old and ≥0.21 over 1 year or daily calcium excretion >4 mg/kg. RESULTS The frequency of IHC was found to be 16.7%. Family history of urolithiasis, parental consanguinity, presentation with abdominal pain, loss of appetite, and discomfort were found to be significantly higher in the IHC group. No association was found between IHC and the recurrence of UTI, presence of vesicoureteral reflux, renal scar formation, and the prognosis. CONCLUSIONS IHC should be considered among the risk factors for UTI and should be investigated particularly in patients with family history of urinary stones and suggestive complaints of IHC.
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Tasian GE, Ziemba J, Casale P. Unilateral hypercalciuria: a stealth culprit in recurrent ipsilateral urolithiasis in children. J Urol 2012; 188:2330-5. [PMID: 23088966 DOI: 10.1016/j.juro.2012.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Hypercalciuria is a risk factor for nephrolithiasis. We hypothesized that children with recurrent stones in 1 but not both kidneys and a normal 24-hour bladder urine calcium-to-creatinine ratio might exhibit isolated hypercalciuria of the affected kidney. MATERIALS AND METHODS Patients 18 years or younger with symptomatic urolithiasis who had undergone ureteroscopic stone removal were included. All subjects underwent 24-hour bladder urinalysis. Subjects with an increased urine calcium-to-creatinine ratio from the 24-hour urine collection were excluded. The 4 subject cohorts defined were 1) single stone episode in 1 kidney, 2) single stone episode in both kidneys, 3) recurrent stone episodes on 1 side and 4) recurrent stone episodes on both sides. All urine collections were obtained at ureteroscopy. Urine was obtained from the bladder and from the renal pelvis of the kidney forming the stone. Spot urine calcium-to-creatinine ratio was determined from these samples. RESULTS A total of 329 patients were included. Nine of 74 subjects (12%) with recurrent stone episodes on 1 side had increased spot urine calcium-to-creatinine ratio from the affected kidney. No patients in the other cohorts had increased spot urine calcium-to-creatinine ratio. Patients who formed recurrent stones in 1 kidney had increased spot urine calcium-to-creatinine ratio in the affected kidney vs other stone formers (ANOVA p <0.001). CONCLUSIONS Unilateral hypercalciuria can occur in children with normal calcium levels in bladder urine. Unilateral hypercalciuria should be considered as a risk factor for nephrolithiasis in children with recurrent stone episodes in 1 kidney only.
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Affiliation(s)
- Gregory E Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
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16
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Abstract
Childhood urolithiasis is an evolving condition with an increasing incidence and prevalence over the last 2 decades. Over that time the underlying cause has shifted from predominantly infectious to metabolic in nature. This review describes the pathophysiology, underlying metabolic abnormalities, clinical presentation, evaluation, and management of childhood urolithiasis. A comprehensive metabolic evaluation is essential for all children with renal calculi, given the high rate of recurrence and the importance of excluding inherited progressive conditions.
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Affiliation(s)
- Lawrence Copelovitch
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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17
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Urinary calcium and uric acid excretion in children with vesicoureteral reflux. Pediatr Nephrol 2012; 27:95-9. [PMID: 21814729 DOI: 10.1007/s00467-011-1936-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 05/22/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
Abstract
Urolithiasis is relatively common in children, and identifiable predisposing factors for stone formation, including metabolic and structural derangements, can be established in most cases. Vesicoureteral reflux (VUR) is a common cause of kidney stone formation. The pathophysiological mechanism of urolithiasis in reflux is related to urinary tract infection and urinary stasis, both of which promote urinary crystal formation, but metabolic causes, such as crystallurias (mostly hypercalciuria), may also be involved in this process. However, few studies on urinary calcium and uric acid excretion in children with VUR have been conducted. We have studied the frequency of hypercalciuria and hyperuricosuria in children with VUR and compared the results with those from a control group. The VUR group comprised 108 children with VUR (19 boys, 89 girls; age range 3 months to 12 years), and the control group comprised 110 healthy children without any history of reflux or urinary tract infection (30 boys, 80 girls; age range 2 months to 12 years). Fasting urine was analyzed for the calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Hypercalciuria was more frequently diagnosed in the VUR patients than in the control group (21.3 vs. 3.6%; P = 0.0001). Significant differences between the two groups were also found for the mean Ca/Cr and UA/Cr ratios (P = 0.0001 and P = 0.0001, respectively). No differences were found in the urinary Ca/Cr or UA/Cr ratios related to VUR grading or unilateral/bilateral VUR in the patient group, with the exception of those for hypercalciuria and mild VUR (P = 0.03). The association of urinary stones and microlithiasis in the VUR group was 29.6%. Our results demonstrate that the frequency of hypercalciuria and hyperuricosuria was higher in pediatric patients with VUR than in healthy children. Knowing this relationship, preventive and therapeutic interventions for stone formation in VUR could be greatly expanded.
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18
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Metabolic Stone Disease in Children. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pediatric reference intervals for random urine calcium, phosphorus and total protein. Pediatr Nephrol 2010; 25:1707-10. [PMID: 20473690 DOI: 10.1007/s00467-010-1544-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/02/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to establish age appropriate reference intervals for calcium (Ca), phosphorus (P) and total protein (UTP) in random urine samples. All analytes were measured using the Roche MODULAR P analyzer and normalized to creatinine (Cr). Our study cohort consisted of 674 boys and 728 girls between 7 and 17 years old (y.o.), which allowed us to determine the central 95% reference intervals with 90% confidence intervals by non-parametric analysis partitioned by both gender and 2-year age intervals for each analyte [i.e. boys in age group 7-9 years (7-9 boys); girls in age group 7-9 years (7-9 girls), etc.]. Results for the upper limits of the central 95% reference interval were: for Ca/Cr, 0.27 (16,17 y.o.) to 0.46 mg/mg (7-9 y.o.) for the girls and 0.26 (16,17 y.o.) to 0.43 mg/mg (7-9 y.o.) for the boys; for P/Cr, 0.85 (16,17 y.o.) to 1.44 mg/mg (7-9 y.o.) for the girls and 0.87 (16,17 y.o.) to 1.68 mg/mg (7-9 y.o.) for the boys; for UTP/Cr, 0.30 (7-9 y.o.) to 0.34 mg/mg (10-12 y.o.) for the girls and 0.19 (16,17, y.o.) to 0.26 mg/mg (13-15 y.o.) for the boys. Upper reference limits decreased with increasing age, and age was a statistically significant variable for all analytes. Eight separate age- and gender-specific reference intervals are proposed per analyte.
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Arpadi SM, McMahon D, Abrams EJ, Bamji M, Purswani M, Engelson ES, Horlick M, Shane E. Effect of bimonthly supplementation with oral cholecalciferol on serum 25-hydroxyvitamin D concentrations in HIV-infected children and adolescents. Pediatrics 2009; 123:e121-6. [PMID: 19117833 PMCID: PMC3110671 DOI: 10.1542/peds.2008-0176] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Vitamin D insufficiency occurs commonly in HIV-infected youth in the United States. In light of the importance of vitamin D for skeletal and nonskeletal health, including innate immunity, developing methods for improving vitamin D status in HIV-infected children and adolescents is an important area of clinical research. The objective of this study was to evaluate the effect of administration of oral cholecalciferol, 100,000 IU every 2 months, and 1 g/day calcium on serum 25-hydroxyvitamin D concentrations, serum and urine calcium, and HIV disease progression during a 12-month period. METHODS HIV-infected children and adolescents who were aged 6 to 16 years were randomly assigned to receive vitamin D (100,000 IU bimonthly) and calcium (1 g/day; n = 29) or double placebo (n = 27). Serum 25-hydroxyvitamin D concentrations as measured by radioimmunoassay, albumin-corrected calcium concentrations, and spot urinary calcium-creatinine ratios were determined monthly. RESULTS No abnormalities in serum calcium concentration were observed. One participant who received placebo developed hypercalciuria. No group differences were seen in the change in CD4 count or CD4% or viral load during 12 months. The overall mean monthly serum 25-hydroxyvitamin D concentrations were higher in the group that received vitamin D and calcium than in the placebo group, as was the monthly serum 25-hydroxyvitamin D area under the curve. After completing 12 months of study, 2 (6.7%) participants in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration <20 ng/mL compared with 14 (50%) in the placebo group. Twelve (44.4%) in the group that received vitamin D and calcium had a trough serum 25-hydroxyvitamin D concentration of > or =30 ng/mL compared with 3 (11.1%) in the placebo group. CONCLUSIONS Administration of oral cholecalciferol to HIV-infected children and adolescents at a dosage of 100,000 IU every 2 months, together with 1 g/day calcium, is safe and results in significant increases in serum 25-hydroxyvitamin D concentrations.
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Affiliation(s)
- Stephen M. Arpadi
- College of Physicians and Surgeons, Sergievsky Center, Mailman School of Public Health, Columbia University, New York, New York,Department of Pediatrics, Mailman School of Public Health, Columbia University, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,St Luke’s-Roosevelt Hospital Center, New York, New York
| | - Donald McMahon
- Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York
| | - Elaine J. Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,Harlem Hospital Center, New York, New York
| | - Marukh Bamji
- Metropolitan Hospital Center, New York, New York
| | | | - Ellen S. Engelson
- St Luke’s-Roosevelt Hospital Center, New York, New York,Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York
| | - Mary Horlick
- Department of Pediatrics, Mailman School of Public Health, Columbia University, New York, New York
| | - Elizabeth Shane
- Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York
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Gonzalez C, Ariceta G, Langman CB, Zibaoui P, Escalona L, Dominguez LF, Rosas MA. Hypercalciuria is the main renal abnormality finding in Human Immunodeficiency Virus-infected children in Venezuela. Eur J Pediatr 2008; 167:509-15. [PMID: 17593389 DOI: 10.1007/s00431-007-0538-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 05/30/2007] [Indexed: 11/25/2022]
Abstract
Kidney involvement in children with Human Immunodeficiency Virus (HIV) infection is increasing in prevalence in parallel with the longer survival of HIV-infected patients and the side-effects of new antiretroviral drugs. However, there are only a few reports describing renal tubular disorders in HIV+ children. This is a cross-sectional, case series study evaluating kidney disease in 26 Venezuelan HIV-infected children. The study cohort consisted of 15 girls and 11 boys, with a median age of 5.9 years (25-75th percentile: 3.6-7.8), who had been treated with antiretrovirals for 2.8 +/- 0.4 years, Overall, the patients were short for their age and gender (Z-height: -3.1; 25-75th percentile: -4.94 to -1.98), and 15 showed signs of mild to moderate malnutrition. All of the children had a normal estimated glomerular filtration rate (136 +/- 22.6 ml/min/1.73 m2), and glomerular involvement was only observed in one patient with isolated proteinuria. None had nephromegaly. In contrast, tubular disorders were commonly found. Hypercalciuria was detected in 16 of the patients (UCa/Cr = 0.28; 25-75th percentile: 0.17-0.54 mg/mg), with five of these showing crystalluria. Eight children showed hyperchloremia, and three had frank metabolic acidosis. Kidney stones were absent in all, but one boy had bilateral medullary nephrocalcinosis. Conclusion, in Venezuelan children, HIV infection per se, or its specific treatment, was commonly associated with renal tubular dysfunction, especially hypercalciuria and acidosis, potentially leading to nephrocalcinosis and growth impairment. We recommend renal tubular evaluation during the follow-up of children with HIV infection.
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Affiliation(s)
- Corina Gonzalez
- Department of Pediatric Infectology, Hospital Doctor Enrique Tejera, University of Carabobo, Valencia, Venezuela
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Seyhan S, Yavascaoglu I, Kilicarslan H, Dogan HS, Kordan Y. Association of vitamin D receptor gene Taq I polymorphism with recurrent urolithiasis in children. Int J Urol 2007; 14:1060-2. [DOI: 10.1111/j.1442-2042.2007.01899.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Koyun M, Güven AG, Filiz S, Akman S, Akbas H, Baysal YE, Dedeoglu N. Screening for hypercalciuria in schoolchildren: what should be the criteria for diagnosis? Pediatr Nephrol 2007; 22:1297-301. [PMID: 17549524 DOI: 10.1007/s00467-007-0528-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/27/2007] [Accepted: 04/03/2007] [Indexed: 12/01/2022]
Abstract
The methodologies to diagnose hypercalciuria have not yet been standardized. The aims of this study were to assess the correlation between urinary calcium/creatinine ratio (UCa/Cr) > or = 0.21 (mg/mg) and 24 h urinary calcium excretions and to determine the reference values of the UCa/Cr ratio among a large population of schoolchildren in southern Turkey. Non-fasting, second morning urine samples were collected from 2,143 children aged 7-14 years. In children with suspected hypercalciuria [UCa/Cr > or = 0.21 (mg/mg)], 24 h urine samples were collected. The 95th percentile values of the UCa/Cr ratio for each age were calculated and showed a decrease in value with advancing age. In all, 269 (12.5%) of the children had UCa/Cr > or = 0.21 (mg/mg), of whom 66 (24.5%) had daily urinary calcium excretion > or =4 mg/kg per day. A weak correlation was found between spot UCa/Cr ratios and daily urinary calcium excretions in children with UCa/Cr > or = 0.21 (r = 0.27). We conclude that a spot UCa/Cr ratio of 0.21 (mg/mg) as the upper limit of normal cannot be used universally to define hypercalciuria. Age-specific reference values for UCa/Cr should be established for each population, to be used as a screening test for hypercalciuria, and the definite diagnosis should be established with 24 h urinary calcium excretion whenever possible.
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Affiliation(s)
- Mustafa Koyun
- Pediatric Nephrology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Abstract
Pediatric and adult stone disease differs in both presentation and treatment. Children can present with a wide range of symptoms varying from flank pain and hematuria to nonspecific symptoms such as irritability and nausea. Although ultrasonography and plain radiographs can play a role in diagnosis and follow-up, the standard of care for a child who presents to the emergency department with a history suggestive of a stone is noncontrast spiral CT. Because there is a high yield in identifying predisposing factors in children with urolithiasis and high recurrence rates, metabolic evaluation of every child with a urinary stone should be undertaken and medical treatment should be given if necessary. With recent advances in technology, stone management has changed from an open surgical approach to less invasive procedures such as extracorporeal shock-wave lithotripsy and endoscopic techniques. Herein, we present a review of the recent literature and offer our own preferences to approaches for treatment.
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Sönmez F, Akçanal B, Altincik A, Yenisey C. Urinary calcium excretion in healthy Turkish children. Int Urol Nephrol 2006; 39:917-22. [PMID: 17043921 DOI: 10.1007/s11255-006-9013-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 04/12/2006] [Indexed: 11/25/2022]
Abstract
The aim of this study was to establish the age related reference percentile values for urinary calcium excretion in healthy Turkish children, and to determine the frequency of hypercalciuria and also the factors affecting urinary calcium excretion. A cross-sectional study was performed in Aydin, in western Turkey during winter. Study population was constituted from seventeen districts of this region (sample size was calculated from a formula using the results of the last population census) by stratified and random sampling methods. Urinary calcium excretion was measured as the calcium/creatinine concentration ratio in the second non-fasting urine samples. A total of 2252 children (1132 male) with a mean age of 8.57 +/- 4.44 years (ranged from 15 days to 15 years) were studied. The mean of urinary calcium/creatinine concentration ratio was calculated as 0.092 +/- 0.123. The percentile values between 3rd and 97th for urinary calcium/creatinine concentration ratio according to age were calculated and shown as multiple line graphs. Hypercalciuria prevalence was found as 9.6% when the upper limit of urinary calcium/creatinine concentration ratio was accepted as 0.21. Urinary calcium/creatinine concentration ratio of the children from different districts, altitudes, and ethnic origins were statistically different. Poor negative correlations were found between urinary calcium/creatinine concentration ratio and age and weight. No differences in urinary calcium/creatinine concentration ratios were observed in terms of sexes, diet, physical activity, urolithiasis in the family, symptoms related to hypercalciuria, amount of calcium in drinking water, and urine strip analysis. In conclusion, reference values for urinary calcium/creatinine concentration ratios should be established for children in each country and also in each geographic region.
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Affiliation(s)
- F Sönmez
- Division of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydin, Türkiye.
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Abstract
Nephrolithiasis is responsible for 1 in 1000 to 1 in 7600 pediatric hospital admissions annually throughout the United States. Seventy-five percent of children with nephrolithiasis have an identifiable predisposition to stone formation. This article reviews the different causes and disease states associated with nephrolithiasis in the pediatric population. The initial evaluation and the metabolic evaluation of children with nephrolithiasis are reviewed. Treatment modalities for the different stone types are also described.
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Affiliation(s)
- Julie A Nicoletta
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14624, USA.
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Sarica K. Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment. ACTA ACUST UNITED AC 2006; 34:96-101. [PMID: 16432692 DOI: 10.1007/s00240-005-0018-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2005] [Indexed: 11/24/2022]
Abstract
Pediatric urolithiasis is an endemic disease in certain parts of the world, namely Turkey and the Far East. As a recurrent pathology which may reveal functional as well and morphologic changes in the urinary tract, environmental factors together with urogenital abnormalities should be evaluated thoroughly in each patient. The aims of management should be complete clearance of stones, treatment of urinary tract infections, preservation of renal function and prevention of stone recurrence. In addition to certain minimally invasive stone removal procedures, treatment of pediatric urolithiasis requires a detailed metabolic evaluation in all patients on an individual basis. Obstructive pathologies have to be corrected immediately and children with a positive family history should be followed carefully with respect to a high likelihood of stone re-growth and recurrence. Although specific management of each metabolic abnormality seems to be the key factor in the medical management of stone disease, as general advice each child should be forced to adequate fluid intake which will reveal the urine volume increase in accordance with the body mass index. Moreover, medical therapeutic agents which increase urine citrate levels should be encouraged.
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Affiliation(s)
- K Sarica
- Medical School, Pahinbey Medical Center, Department of Urology, University of Gaziantep, Gaziantep, Turkey.
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Mir S, Serdaroglu E. Quantification of hypercalciuria with the urine calcium osmolality ratio in children. Pediatr Nephrol 2005; 20:1562-5. [PMID: 16133062 DOI: 10.1007/s00467-005-1992-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 04/22/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
Hypercalciuria is a major risk factor for kidney stones and hematuria in children. Calcium measurements in 24-h collected urine (mg/kg/d) is still essential for the hypercalciuria diagnose but collection of 24 hour urine is difficult especially in young children. A prospective study was conducted to compare calcium/osmolality (Uca/Uosm) ratio to calcium/creatinine (Uea/Ucr) and to correlate both ratios to 24-hour urine calcium excretion (mg/kg/d) and the value of Uca/Uosm ratio for diagnosis of hypercalciuria in children. Two hundred and fifteen patients aged between 3 to 15 years (median 8 years) were included in the study. Early morning second urine samples and 24-hour collected urine samples were analyzed. The 24-hour urinary calcium excretions were significantly correlated with Uca/Ucr and Uca/Uosm ratio (r =0.67, P<0.001 and r =0.61, P<0.001 respectively). The accepted hypercalciuria level of 24-hour urine calcium of 4 mg/kg/day coincides with Uca/Ucr ratio of 0.18 mg/mg (sensitivity 90.0%, specificity 84.4%) and with Uca/Uosm ratio of 0.14 mg/l/mOsm/kg (sensitivity 90%, specificity 81.0%) in the ROC curve analysis. Positive and negative predictive values were found 98.3% and 39.1% for Uca/Uosm ratio and respectively 43.9% and 98.4% for Uca/Ucr ratio. In conclusion Uca/Uosm ratio is a good marker of hypercalciuria as well as Uca/Ucr ratio and may be used for screening of hypercalciuria.
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Affiliation(s)
- Sevgi Mir
- Department of Pediatric Nephrology, Ege University Medical School, Izmir, Turkey
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Abstract
Childhood urolithiasis remains endemic in certain parts of the world, namely, Turkey and the Far East. The prevalence of nephrolithiasis in North American children varies widely among geographic regions and accounts for 1 per 1000 to 1 per 7600 pediatric hospital admissions. Stones occur in children of all ages. The clinical manifestations of stone disease are often more subtle in children when compared with the dramatic adult presentation. This article discusses the evaluation and medical management of pediatric stone disease.
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Affiliation(s)
- Sharon M Bartosh
- Department of Pediatrics, University of Wisconsin, University of Wisconsin Children's Hospital, 600 Highland Avenue, Madison, WI 53792, USA
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Müller D, Kausalya PJ, Claverie-Martin F, Meij IC, Eggert P, Garcia-Nieto V, Hunziker W. A novel claudin 16 mutation associated with childhood hypercalciuria abolishes binding to ZO-1 and results in lysosomal mistargeting. Am J Hum Genet 2003; 73:1293-301. [PMID: 14628289 PMCID: PMC1180395 DOI: 10.1086/380418] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2003] [Accepted: 09/15/2003] [Indexed: 11/03/2022] Open
Abstract
Mutations in the gene coding for the renal tight junction protein claudin 16 cause familial hypomagnesemia with hypercalciuria and nephrocalcinosis, an autosomal recessive disorder of renal Ca(2+) and Mg(2+) handling that progressively leads to chronic renal failure, with nephrolithiasis having been reported in heterozygous carriers. Screening a cohort of 11 families with idiopathic hypercalciuria identified a novel homozygous mutation in the claudin 16 gene in two families. In contrast to classical symptoms of familial hypomagnesemia with hypercalciuria and nephrocalcinosis, the patients displayed serious but self-limiting childhood hypercalciuria with preserved glomerular filtration rate. The mutation results in inactivation of a PDZ-domain binding motif, thereby disabling the association of the tight junction scaffolding protein ZO-1 with claudin 16. In contrast to wild-type claudin 16, the mutant no longer localizes to tight junctions in kidney epithelial cells but instead accumulates in lysosomes. Thus, mutations at different intragenic sites in the claudin 16 gene may lead to particular clinical phenotypes with a distinct prognosis. Mutations in claudin 16 that affect interaction with ZO-1 lead to lysosomal mistargeting, providing-for the first time, to our knowledge-insight into the molecular mechanism of a disease-associated mutation in the claudin 16 gene.
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Affiliation(s)
- Dominik Müller
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - P. Jaya Kausalya
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - Felix Claverie-Martin
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - Iwan C. Meij
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - Paul Eggert
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - Victor Garcia-Nieto
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
| | - Walter Hunziker
- Charité Children’s Hospital, Department of Pediatric Nephrology, Berlin; Epithelial Cell Biology Laboratory, Institute of Molecular and Cell Biology, Singapore; Research and Pediatric Nephrology Units, Nuestra Senora de Candelaria University Hospital, Santa Cruz de Tenerife, Tenerife, Spain; Department of Pharmacology/Toxicology, Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands; and University Children’s Hospital Kiel, Kiel, Germany
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Coward RJM, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, van't Hoff WG. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 2003; 88:962-5. [PMID: 14612355 PMCID: PMC1719348 DOI: 10.1136/adc.88.11.962] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The previous epidemiological study of paediatric nephrolithiasis in Britain was conducted more than 30 years ago. AIMS To examine the presenting features, predisposing factors, and treatment strategies used in paediatric stones presenting to a British centre over the past five years. METHODS A total of 121 children presented with a urinary tract renal stone, to one adult and one paediatric centre, over a five year period (1997-2001). All children were reviewed in a dedicated stone clinic and had a full infective and metabolic stone investigative work up. Treatment was assessed by retrospective hospital note review. RESULTS A metabolic abnormality was found in 44% of children, 30% were classified as infective, and 26% idiopathic. Bilateral stones on presentation occurred in 26% of the metabolic group compared to 12% in the infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting urinary tract infection was common (49%) in the metabolic group. Surgically, minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and endoscopy) were used in 68% of patients. CONCLUSIONS There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years. Underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection. Treatment has progressed, especially surgically, with sophisticated minimally invasive techniques now employed. All children with renal stones should have a metabolic screen.
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Affiliation(s)
- R J M Coward
- Nephro-Urology Unit, Institute of Child Health, London, UK.
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32
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Abstract
Urinary stones in children are usually genetic and most commonly due to hypercalciuria. Symptoms of urolithiasis in children differ among age groups. Isolated hematuria in children may be caused by hypercalciuria and precede calculus formation. Careful evaluation successfully identifies the cause of urinary stones in most children, although diagnostic criteria may vary in different age groups. Therapies should be targeted to the underlying diagnosis.
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Affiliation(s)
- F Bruder Stapleton
- Children's Hospital and Regional Medical Center, University of Washington Seattle, 4800 Sand Point Way North East, CH-65, Seattle, WA 98105, USA.
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Berçem G, Cevit O, Toksoy HB, Içagasioglu D, Gültekin A, Tanzer F. Asymptomatic hypercalciuria: prevalence and metabolic characteristics. Indian J Pediatr 2001; 68:315-8. [PMID: 11370436 DOI: 10.1007/bf02721835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypercalciuria is of continuing interest as a risk factor for kidney stones in children. We screened 592 healthy Turkish children (308 boys, 284 girls, aged 3 month-16 years) for hypercalciuria by measurement of urinary calcium/creatinine (UCa/Cr) ratio in the second-morning urine samples. Hypercalciuria was noted in 17 children (2.9%), 9 of them were boy and 8 of them were girl. Oral calcium-loading test could only be done in 7 children who were diagnosed as having hypercalciuria, and it revealed absorptive hypercalciuria in 2 cases and renal hypercalciuria in no cases. The frequency of a family history of urolithiasis in asymptomatic hypercalciuric children was 50%. Median UCa/Cr ratios and urinary magnesium/creatinine (UMg/Cr) ratios were 0.11 and 0.10 and the 97th percentiles were 0.32 and 0.23 respectively. The UCa/Cr ratio in second-morning urine samples was correlated with the UMg/Cr ratio (r = 0.44) and was independent of age and sex.
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Affiliation(s)
- G Berçem
- Department of Pediatrics, Cumhuriyet University Faculty of Medicine, Sivas
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Mocan H, Yildiran A, Çamlibel T, Mocan Kuzey G. Microscopic nephrocalcinosis and hypercalciuria in nephrotic syndrome. Hum Pathol 2000. [DOI: 10.1016/s0046-8177(00)80005-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Matos V, van Melle G, Boulat O, Markert M, Bachmann C, Guignard JP. Urinary phosphate/creatinine, calcium/creatinine, and magnesium/creatinine ratios in a healthy pediatric population. J Pediatr 1997; 131:252-7. [PMID: 9290612 DOI: 10.1016/s0022-3476(97)70162-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine reference values for urinary phosphate/creatinine (Cr) concentration ratios and to complete reference values for urinary calcium/creatinine and magnesium/creatinine ratios in the second morning urine sample of healthy infants, children, and adolescents. DESIGN Urinary P/Cr, Ca/Cr, and Mg/Cr ratios were determined from the second morning urine sample. Two urine samples were obtained 1 week apart from most subjects to assess reproducibility. SETTING Kindergartens and schools of Lausanne, Switzerland. PARTICIPANTS A total of 410 healthy children aged 1 month to 17 years (197 girls and 213 boys) participated in the study. RESULTS The 5th and 95th percentiles were estimated from 664 urine samples. There were no differences related to sex. A nonlinear regression in terms of age was used to smooth the estimated percentiles yielding reference curves from which critical values may be obtained for any given age. The 95th percentile for urinary Ca/Cr and Mg/Cr agreed with previously reported values in children older than 7 years. The upper limit of the three solute/creatinine ratios decreased significantly with age: for urinary P/Cr from 19.0 mol/mol at 1 month to 2.7 at 14 years; for urinary Ca/Cr from 2.2 to 0.7 mol/mol, and for urinary Mg/Cr from 2.2 to 0.6 mol/mol. Lower limits varied little. Interindividual and intraindividual variations decreased with age. CONCLUSIONS Urinary P/Cr, Ca/Cr, and Mg/Cr ratios vary strongly with age. We provide reference values, expressed both in SI and in mass units, for urinary P/Cr, Ca/Cr, and Mg/Cr in children aged one month to 17 years.
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Affiliation(s)
- V Matos
- Service de Pédiatrie, Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
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36
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Jones CA, King S, Shaw NJ, Judd BA. Renal calcification in preterm infants: follow up at 4-5 years. Arch Dis Child Fetal Neonatal Ed 1997; 76:F185-9. [PMID: 9175949 PMCID: PMC1720638 DOI: 10.1136/fn.76.3.f185] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To determine the consequences of renal calcification in preterm infants. METHODS A cohort of 11 preterm babies was studied at the age of 4 to 5 years. They had had renal calcification as neonates. Seventeen matched controls were also studied. Each child had a renal ultrasound scan, a calcium load test, and a desmopressin test for renal concentrating ability (RCA). The study group also had glomerular filtration rate (GFR) estimated, using the height:creatinine ratio, and tubular phosphate reabsorption, without phosphate load, per glomerular filtration rate (Tp/GFR) calculated, RESULTS In the study group the median GFR was 61 ml/min/1.73m2 (range 46-79 ml/min/1.73m2) and the median calculated Tp/GFR SD score was -0.94 (range -2.8-0.68). Five children out of the study group had ultrasonic evidence of renal calcification. There was no significant difference between the two groups in renal size, calciuria, before or after calcium load, or RCA. Eight children (three patients, five controls) had an abnormal calcium load test. The RCA of the children in the study and control groups combined was below that of published values, with a median calculated SD score -0.71 (95% CI -1.21 to -0.23). CONCLUSIONS There was evidence of renal dysfunction in children who had been born preterm. Renal calcification detected in the neonatal period does not seem to be a major predisposing factor for the abnormalities of renal function subsequently observed in these infants.
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Abstract
Hypercalciuria is a rare biological symptom with multiple possible etiologies in children. Normal calcium excretion rate in children is defined as lower than 4 mg/kg per day, significantly higher values being observed in infants. When using urinary calcium: creatinine ratio, normal values are below 0.22 mg/mg in children, and below 0.6 to 0.8 mg/mg in infants. In our experience half patients with hypercalciuria have idiopathic hypercalciuria. Idiopathic hypercalciuria can be hereditary with a dominant autosomal mode of inheritance. Its pathophysiology is unclear, increased calcium intestinal absorption and impaired renal tubular calcium reabsorption being the two main underlying anomalies. Patients with hypercalciuria should be informed about the risk of urolithiasis and its possible prevention by a high water intake. In those patients with nephrocalcinosis or recurrent episodes of lithiasis, hydrochlorothiazide can be effective in reducing hypercalciuria. However, adverse effects of hydrochlorothiazide on serum lipids have been recently reported and make this treatment questionable in the long term.
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Affiliation(s)
- R Dumas
- Service de pédiatrie I, hôpital Arnaud-de-Villeneuve, Montpellier, France
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39
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Nicolaidou P, Themeli S, Karpathios T, Georgouli H, Athanassaki K, Xaidara A, Messaritakis J. Family Pattern of Idiopathic Hypercalciuria and its Subtypes. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66386-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Polyxeni Nicolaidou
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Sofia Themeli
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Themistoklis Karpathios
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Helen Georgouli
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Korina Athanassaki
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - Athina Xaidara
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
| | - John Messaritakis
- First Department of Pediatrics, Athens University and Second Pediatric Department, “P. & A. Kyriakou” Children's Hospital, Athens, Greece
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40
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Landau D, Shalev H, Ohaly M, Carmi R. Infantile variant of Bartter syndrome and sensorineural deafness: a new autosomal recessive disorder. AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 59:454-9. [PMID: 8585565 DOI: 10.1002/ajmg.1320590411] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The infantile variant of Bartter syndrome (IBS) is usually associated with maternal polyhydramnios, premature birth, postnatal polyuria and hypokalemic hypochloremic metabolic alkalosis and a typical appearance. IBS is thought to be an autosomal recessive trait. Several congenital tubular defects are associated with sensorineural deafness (SND). However, an association between the IBS and SND has not been reported so far. Here we describe 5 children of an extended consanguineous Bedouin family with IBS and SND. In 3 of the cases, the typical electrolyte imbalance and facial appearance were detected neonatally. SND was detected as early as age 1 month, suggesting either coincidental homozygotization of 2 recessive genes or a pleiotropic effect of one autosomal recessive gene. This association suggests that evaluation of SND is warranted in every case of IBS.
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Affiliation(s)
- D Landau
- Department of Pediatrics, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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41
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Abstract
We describe 11 infants with congenital lactase deficiency, whose age at diagnosis varied from 6 to 88 days. At the time of admission, 7 of 10 infants had hypercalcemia. Five of the seven infants for whom renal ultrasonography was performed at the time of diagnosis had medullary nephrocalcinosis. Hypercalcemia ceased within a week of the start of a lactose-free diet. At the time of reevaluation, at the ages of 2 to 10 years, one of the patients still had hypercalciuria and nephrocalcinosis was still present in 3 of 11 patients. The mechanism of hypercalcemia is unclear but may be related to metabolic acidosis or may be promoted by the lactose effect (i.e., by nonhydrolyzed lactose that has a direct enhancing effect on calcium absorption in the ileum).
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Affiliation(s)
- T Saarela
- Department of Pediatrics, University of Oulu, Finland
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42
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Proesmans W, De Cock P, Eyskens B. A toddler with Down syndrome, hypercalcaemia, hypercalciuria, medullary nephrocalcinosis and renal failure. Pediatr Nephrol 1995; 9:112-4; discussion 115-6. [PMID: 7742209 DOI: 10.1007/bf00858987] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- W Proesmans
- Department of Paediatrics, University of Leuven, University Hospital, Belgium
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43
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Reusz GS, Dobos M, Byrd D, Sallay P, Miltényi M, Tulassay T. Urinary calcium and oxalate excretion in children. Pediatr Nephrol 1995; 9:39-44. [PMID: 7742220 DOI: 10.1007/bf00858966] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have established normal values for calcium/creatinine (Ca/Cr) and oxalate/creatinine (Ox/Cr) ratios in 25 infants (aged 1-7 days) and 391 children (aged 1 month to 14.5 years) and compared these with values obtained in 137 children with post-glomerular haematuria and 27 with nephrolithiasis. Oxalate was measured by ion chromatography. Nomograms of Marshall and Robertson were used to calculate urine saturation to calcium oxalate. The Ca/Cr ratio was normally distributed whereas the Ox/Cr ratio had a log-normal distribution. The molar ratio of Ca/Cr was the lowest in the first days of life and the highest between 7 month and 1.5 years (mean +/- SD = 0.39 +/- 0.28 mmol/mmol). Following a slight decrease it stabilised by the age of 6 years (0.34 +/- 0.19 mmol/mmol). The highest Ox/Cr values were measured during the 1st month of life [geometric mean 133 (range 61-280) mumol/mmol], followed by a gradual decrease until 11 years of age [mean 24 (range 6-82) mumol/mmol]. Thirty-six haematuric children had hypercalciuria (26%), 23 had absorptive hypercalciuria, 13 renal type. Children with absorptive hypercalciuria on a calcium-restricted diet had significantly higher oxalate excretion than those with renal hypercalciuria and the control group [38 (range 28-49) vs. 22 (range 16-29) and 23 (range 22-27) mumol/mol respectively, P < 0.01]. Calcium oxalate urine saturation of stone patients was higher than that of patients with haematuria and the normal population (1.18 +/- 0.05 vs. 1.06 +/- 0.03, P < 0.03 and 0.84 +/- 0.03, P < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G S Reusz
- First Department of Paediatrics, Semmelweis University Medical School, Budapest, Hungary
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44
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Abstract
Urinary calcium excretion was measured in an unselected population of 153 healthy Swedish children aged 2-18 years. Urine was collected after an ordinary meal. Urinary calcium excretion was measured as the calcium/creatinine concentration ratio (UCa/Cr) and expressed in mmol/l per mmol/l. UCa/Cr was 0.44 +/- 0.379 (mean +/- SD). As the UCa/Cr in this childhood population was not distributed in a normal manner, the results are more correctly presented as the 50th (0.33) and 97th (1.5) centiles. There was a weak but significant correlation between UCa/Cr and age, with higher values in the lower age groups. There was no correlation between UCa/Cr and the anamnestic intake of cow's milk. Repeated samples from some children showed a coefficient of variation between days of 30-40%. The upper limits of normal UCa/Cr (97th centile = 1.5; +2 SD = 1.2) in this investigation were higher than what is considered normal by others. In spite of this, none of the children had a history of renal stone disease or any other symptoms of hypercalciuria. Renal stone disease is thought to be rare in Swedish children although the real incidence is not known. The diagnosis of hypercalciuria should be based on repeated samples from an individual with symptoms and related to age-related reference values from the same population group.
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Affiliation(s)
- E Esbjörner
- Department of Paediatrics, Orebro Medical Centre Hospital, Sweden
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45
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Abstract
Hematuria is one of the most common urinary abnormalities found in children. When hypercalciuria was identified as a potential etiology of painless hematuria, many questions arose concerning the general importance of this observation. Subsequently, increased uric acid excretion also has been purported to cause hematuria in children. This review traces the history of these observations and describes the clinical characteristics of the clinical syndrome of hematuria associated with hypercalciuria and hyperuricosuria. Diagnostic criteria of excessive urinary excretion of calcium and uric acid are reviewed; differences in urinary calcium and uric acid excretion between infants and older children are emphasized. Aside from urolithiasis, few long-term consequences from hypercalciuria or hyperuricosuria have been identified, although some debate exists concerning the effect of chronic hypercalciuria upon bone mineralization.
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Affiliation(s)
- F B Stapleton
- Department of Pediatrics, State University of New York at Buffalo, New York
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46
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Abstract
A work-up of a child with suspected hematuria should be undertaken once the primary physician has determined that there actually are red blood cells in the urine and that the hematuria is persistent. Evaluation of a child with persistent microscopic hematuria is facilitated with the determination of whether the blood originates from the glomeruli or whether it comes from elsewhere in the urinary tract. Clues to a glomerular origin include the presence of other manifestations of glomerular disease such as significant proteinuria, RBC casts, and dysmorphic erythrocytes in the urinary sediment, hypertension, and renal insufficiency. Clues to the blood originating from the lower urinary tract include blood clots in the urine, normal erythrocyte morphology, and a pertinent history pointing to the lower tract such as that of trauma, urolithiasis, urological or vascular abnormality, or symptoms of bladder inflammation. The initial evaluation should include a detailed patient history and family history as well as a careful physical examination looking for clues to the presence of a familial, hereditary, or chronic kidney disease. A logical, stepwise initial work-up should follow with the goal of ruling out life-threatening and treatable diseases. If there are no indications for immediate further intervention and the cause of the hematuria remains unclear after the initial work-up has been completed, the parents and patient should be reassured that there are no life-threatening conditions and that although the etiology of the blood in the urine is yet unknown, there is time to follow the patient and plan for additional studies if and when they are indicated. The family's concerns (ie, "Is this cancer?," "Will my child require dialysis and transplantation?") should be addressed frankly, and the physician should mention those diagnoses that may lead to renal failure, but have not been absolutely ruled out yet before a kidney biopsy has been performed, such as Alport's syndrome and IgA nephropathy. The child with isolated microhematuria should be evaluated regularly with urinalyses looking for persistence of the hematuria and appearance of proteinuria, blood pressure measurements, and renal function tests. If the microhematuria persists for 6 to 12 months, a kidney biopsy should be considered.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- O Yadin
- UCLA School of Medicine 90024
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47
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Reusz GS, Dobos M, Tulassay T, Miltényi M. Hydrochlorothiazide treatment of children with hypercalciuria: effects and side effects. Pediatr Nephrol 1993; 7:699-702. [PMID: 8130085 DOI: 10.1007/bf01213325] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Urinary excretion of calcium and the changes in serum cholesterol fractions were investigated in 15 children with renal hypercalciuria, following 3-month hydrochlorothiazide (HCT) treatment (daily dose 1 mg/kg). Urinary calcium excretion (expressed as the ratio of calcium to creatinine) reached its lowest value after 2 weeks. It was still below the initial value at the end of the 3rd month of treatment (0.84 +/- 0.06, 0.29 +/- 0.03 and 0.6 +/- 0.09 mmol/mmol, respectively). A significant rise in the total serum cholesterol level (4.64 +/- 0.23 vs. 4.25 +/- 0.18 mmol/l before treatment, P < 0.01) and the low-density lipoprotein (LDL)-cholesterol fraction (2.6 +/- 0.24 vs. 2.31 +/- 0.31 before treatment, P < 0.01) was observed at the end of the 3rd month, while high-density lipoprotein (HDL)-cholesterol was slightly decreased. A significant elevation of the LDL/HDL ratio was also observed (from 1.76 +/- 0.17 to 2.2 +/- 0.17, P < 0.001), indicating an increase in the atherogenic cholesterol fractions. The risks and benefits of the thiazide therapy should be considered before starting long-term treatment of children with hypercalciuria and haematuria or renal stone disease.
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Affiliation(s)
- G S Reusz
- First Department of Paediatrics, Semmelweis University Medical School, Budapest, Hungary
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48
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Abstract
Urolithiasis in pediatric patients has been perceived as uncommon, and the appropriate evaluation and management have been controversial. To determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithiasis encountered in a referral center, we retrospectively assessed 221 patients (113 girls and 108 boys) with urolithiasis examined at the Mayo Clinic between 1965 and 1987. The median age at onset of symptoms was 11 6/12 years among the female patients and 10 6/12 years among the male patients. Analysis of stone constituents in 122 patients showed the proportion of calcium oxalate (44.7%), calcium phosphate (23.6%), and cystine (8.1%) stones to be similar in all age-groups. Overall, struvite stones were found in 17.1% and uric acid stones in 1.6% of patients. Conditions that predisposed to metabolic urolithiasis were identified in 115 patients (52%). Hypercalciuria was confirmed in 49 of 145 patients (33.8%) and hyperoxaluria in 25 of 124 (20.2%). Eight of 96 patients had hyperuricosuria, and 5 of 54 had hypocitraturia. Forty-one patients (18.6%) had infection-related stones. Of 66 patients with structural anomalies of the genitourinary tract, 24 (36%) had metabolic abnormalities and 26 (39%) had chronic infection. Among patients with chronic infection, 29% had metabolic abnormalities. Of the 221 patients, 148 (67%) had two or more stones during a mean follow-up of 59 months. Among 140 patients with 12 months or more of follow-up, metabolic activity was present in 31 (22.1%) at the time of most recent examination. Overall, 166 of 221 children (75.1%) were found to have factors that predisposed to urolithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D S Milliner
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905
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49
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Abstract
We analysed some genetic and environmental factors influencing renal (RH) and absorptive hypercalciuria (AH) the main subtypes of idiopathic hypercalciuria (IH). Their distinction is essential in the prevention and treatment of urolithiasis. Twenty-one children admitted for renal stones had IH (8 RH and 13 AH). Their families were investigated with the participation of a total of 68 family members including 62 first-degree relatives. They were all normocalcaemic. Their urinary calcium excretion was measured on at least two occasions, and they underwent a calcium restriction--calcium loading test. Each subject was interviewed with reference to medical history, drug administration, social conditions, and nutritional habits. Pedigree analysis suggested a higher rate of familiarity and autosomal dominant inheritance of RH whereas no such pattern was found among the relatives of patients with AH. The interviews disclosed a distinct preference for calcium-rich foods in subjects with AH, while RH and normocalciuric individuals preferred a low-calcium diet. We conclude that the subtypes of IH are genetically different. RH is most probably inherited as an autosomal dominant trait (or has at least an autosomal dominant form), whereas AH is more likely to be associated with nutritional factors.
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Affiliation(s)
- F Harangi
- Department of Paediatrics, University Medical School, Pécs, Hungary
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De Santo NG, Di Iorio B, Capasso G, Paduano C, Stamler R, Langman CB, Stamler J. Population based data on urinary excretion of calcium, magnesium, oxalate, phosphate and uric acid in children from Cimitile (southern Italy). Pediatr Nephrol 1992; 6:149-57. [PMID: 1571211 DOI: 10.1007/bf00866297] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Population based data on 24-h urinary excretion of calcium, oxalate, magnesium, phosphate, uric acid and creatinine were collected from 220 children (aged 3-16 years) living in Cimitile, Campania, southern Italy. Mean excretion rates for 7 days were correlated with age, body weight, body mass index and height. The prevalence of hypercalciuria (greater than 4 mg/kg body weight) and of hyperoxaluria (greater than 60 mg/day) were 9.1% and 1.8%, respectively. The same 20 children were also identified as hypercalciuric when a calcium/creatinine ratio of greater than 0.15 was considered. No significant differences between boys and girls were found in the urinary excretion of the five constituents implicated in urolithiasis. The study data provide additional childhood reference values for urinary excretion of compounds related to stone formation.
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Affiliation(s)
- N G De Santo
- Department of Paediatric Nephrology, 1st Faculty of Medicine, University Federico II, Naples, Italy
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