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Koo KC, Halawani A, Wong VK, Lange D, Chew BH. Monogenic features of urolithiasis: A comprehensive review. Asian J Urol 2024; 11:169-179. [PMID: 38680588 PMCID: PMC11053333 DOI: 10.1016/j.ajur.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/28/2023] [Indexed: 05/01/2024] Open
Abstract
Objective Urolithiasis formation has been attributed to environmental and dietary factors. However, evidence is accumulating that genetic background can contribute to urolithiasis formation. Advancements in the identification of monogenic causes using high-throughput sequencing technologies have shown that urolithiasis has a strong heritable component. Methods This review describes monogenic factors implicated in a genetic predisposition to urolithiasis. Peer-reviewed journals were evaluated by a PubMed search until July 2023 to summarize disorders associated with monogenic traits, and discuss clinical implications of identification of patients genetically susceptible to urolithiasis formation. Results Given that more than 80% of urolithiases cases are associated with calcium accumulation, studies have focused mainly on monogenetic contributors to hypercalciuric urolithiases, leading to the identification of receptors, channels, and transporters involved in the regulation of calcium renal tubular reabsorption. Nevertheless, available candidate genes and linkage methods have a low resolution for evaluation of the effects of genetic components versus those of environmental, dietary, and hormonal factors, and genotypes remain undetermined in the majority of urolithiasis formers. Conclusion The pathophysiology underlying urolithiasis formation is complex and multifactorial, but evidence strongly suggests the existence of numerous monogenic causes of urolithiasis in humans.
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Affiliation(s)
- Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Victor K.F. Wong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Dirk Lange
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ben H. Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
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Moraleda Mesa T, de la Torre Sandoval C, Duque González S, Rolo Álvarez AK, Luis Yanes MI, García Nieto VM. Hypouricemia with hypercalciuria: Longitudinal study and review of the topic. Nefrologia 2024; 44:233-240. [PMID: 38631961 DOI: 10.1016/j.nefroe.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The association of hypouricemia and hypercalciuria is rare. In 1974 a new syndrome named Hypouricemia with hypercalciuria and decreased bone density was described. Afterwards, some cases with such association were published in which the fractional excretion of urate was higher than 20ml/100ml FGR. We have analyzed a series of children who were diagnosed with hypouricemia and hypercalciuria and who were monitored. The aim of this study was to determine whether our patients could be affected by the aforementioned syndrome or be carriers of a variant of idiopathic hypercalciuria. PATIENTS AND METHODS Retrospective longitudinal study in which the medical records of eight patients (5V, 3M) diagnosed with hypouricemia and hypercalciuria in childhood. Clinical features at diagnosis, ultrasound and densitometric findings and selected biochemical variables were noted, with special emphasis on renal tubular handling of urate. Results were compared with 36 children with idiopathic hypercalciuria without hypouricemia (14V, 22M). RESULTS In the hypouricemia group baseline urate levels were 1.9 (0.3) mg/dl (range: 1.5-2) and first day urine calcium/creatinine ratio 0.27 (0.05) mg/mg (range: 0.23-0.31). In all cases fractional urate excretion was less than 20ml/100ml FGR. The z-DMO values were less than -1 in 4/8 cases. At the last follow-up only three cases still had an elevated calcium/creatinine ratio and in all of them the urates levels was greater than 2mg/dl. The z-DMO value had improved in five cases and worsened in three others. In relation to the group without hypouricemia, no differences were observed between the various parameters studied including the z-DMO value, with the exception of fractional excretion and tubular urate reabsorption although plasmatic uric acid levels were still significantly lower. CONCLUSION Our patients with hypercalciuria and hypouricemia would be affected by a variant of idiopathic hypercalciuria in which, due to an unknown cause, the proximal tubular reabsorption of urate is modestly reduced and improves over time. Hypouricemia with hypercalciuria and decreased bone density may not be a specific entity.
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Affiliation(s)
| | | | - Sara Duque González
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Ana Karina Rolo Álvarez
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - María Isabel Luis Yanes
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Víctor M García Nieto
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
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3
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Peris Vidal A, Ferrando Monleón S, Marín Serra J, Quiñones-Torrelo C, Hervás Andrés A, Fons Moreno J, Hernández Marco R. Urinary excretion of calcium, phosphate, magnesium, and uric acid in healthy infants and young children. Influence of feeding practices in early infancy. Pediatr Nephrol 2024; 39:761-770. [PMID: 37755464 DOI: 10.1007/s00467-023-06145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Reference values for urinary calcium (Ca) and other solutes/creatinine (Cr) ratios in infants and young children are scarce. Its variation with type of lactation administered, breastfed (BF) or formula (F), is incompletely known. METHODS A total of 511 spot urine samples from 136 children, aged 6 days to < 5 years, was collected. Urine was collected no fasting in infants < 18 months and first morning fasting in children aged 2.5-4 years. Urinary osmolality, Cr, urea, Ca, phosphate (P), magnesium (Mg), and uric acid (UA) were determined. Values are expressed as solute-to-Cr ratio. RESULTS Urinary values were grouped according to the child's age: 6-17 days (G1), 1-5 months (G2), 6-12 months (G3), 13-18 months (G4), and 2.5-4 years (G5). G1 was excluded; Ca/Cr and UA/Cr (95th percentile) decreased with age (G2 vs. G5) from 1.64 to 0.39 and 2.33 to 0.83 mg/mg, respectively. The P/Cr median rises significantly with age from 0.31 (G2) to 1.66 mg/mg (G5). Mg/Cr was similar in all groups (median 0.20, 95th percentile 0.37 mg/mg). Ca/Cr (95th percentile) of BF infants was 1.80 mg/mg (< 3 months) and 1.63 mg/mg (3-5 months), much higher than F infants (0.93 and 0.90 mg/mg, respectively). P/Cr and P/Ca were lower in BF infants. CONCLUSIONS Values for urinary Ca/Cr, P/Cr, Mg/Cr, and UA/Cr in infants and children < 5 years were updated. BF infants < 6 months showed higher Ca/Cr and lower P/Cr than F infants. New cutoff values to diagnose hypercalciuria in infants < 6 months, according to the type of lactation, are proposed.
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Affiliation(s)
| | - Susana Ferrando Monleón
- Pediatric Service, Hospital Clínico, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
| | - Juan Marín Serra
- Pediatric Service, Hospital Clínico, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
| | | | | | | | - Roberto Hernández Marco
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
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4
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Molecular mechanisms altering tubular calcium reabsorption. Pediatr Nephrol 2022; 37:707-718. [PMID: 33796889 DOI: 10.1007/s00467-021-05049-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/12/2021] [Accepted: 03/09/2021] [Indexed: 12/09/2022]
Abstract
The majority of calcium filtered by the glomerulus is reabsorbed along the nephron. Most is reabsorbed from the proximal tubule (> 60%) via a paracellular pathway composed of the tight junction proteins claudins-2 and -12, a process driven by sodium and consequently water reabsorption. The thick ascending limb reabsorbs the next greatest amount of calcium (20-25%), also by a paracellular pathway composed of claudins-16 and -19. This pathway is regulated by the CaSR, whose activity increases the expression of claudin-14, a protein that blocks paracellular calcium reabsorption. The fine tuning of urinary calcium excretion occurs in the distal convoluted and connecting tubule by a transcellular pathway composed of the apical calcium channel TRPV5, the calcium shuttling protein calbindin-D28K and the basolateral proteins PMCA1b and the sodium calcium exchanger, NCX. Not surprisingly, mutations in a subset of these genes cause monogenic disorders with hypercalciuria as a part of the phenotype. More commonly, "idiopathic" hypercalciuria is encountered clinically with genetic variations in CLDN14, the CASR and TRPV5 associating with kidney stones and increased urinary calcium excretion. An understanding of the molecular pathways conferring kidney tubular calcium reabsorption is employed in this review to help explain how dietary and medical interventions for this disorder lower urinary calcium excretion.
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Perez-Suarez G, Yanes MIL, de Basoa MCMF, Almeida ES, García Nieto VM. Evolution of bone mineral density in patients with idiopathic hypercalciuria: a 20-year longitudinal study. Pediatr Nephrol 2021; 36:661-667. [PMID: 32980941 DOI: 10.1007/s00467-020-04754-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/06/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several recent studies reported bone mineral density (BMD) reduction in pediatric patients with idiopathic hypercalciuria (IH). This longitudinal study aimed to evaluate BMD evolution in IH patients through three bone densitometry studies conducted over 20 years on average. A second objective was to evaluate urine calcium and citrate excretion during this period. METHODS Case notes of 34 patients diagnosed with IH at age 7.9 ± 3, alongside results of two bone densitometry studies, performed at 10.5 ± 2.7 (BMD1) and 14.5 ± 2.7 (BMD2) years of age, were reviewed. Patients underwent a third densitometry study in adulthood (BMD3) aged 28.3 ± 2.9. Mean follow-up duration (time-lapse between BMD1 and BMD3) was 17.7 ± 1.4 years. RESULTS Statistically significant differences were found between z-BMD3 (- 0.85 ± 1.10) and z-BMD1 (- 1.47 ± 0.99) (P = 0.001) as well as between z-BMD3 and z-BMD2 (- 1.33 ± 1.20) (P = 0.016). At the end of follow-up, z-BMD3 was superior to z-BMD2 in 23 adult patients (67.6%) and lower in 11 patients (5M, 6F; 32.3%). Both men and women showed increased bone mass over time, although such increases were significant only for women. The gradual decrease observed in calcium/creatinine and citrate/creatinine ratios could be related to improvement in osteoblastic activity and especially reduction in osteoclastic activity. CONCLUSIONS In patients with IH, BMD improves, which may be related especially to female sex, increment of body mass, and reduction in bone resorption. Upon reaching adulthood, urine calcium and citrate excretion tend to decrease so lithogenic risk still remains. The cause of the latter is unknown, although it likely relates to changes in bone activity.
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Affiliation(s)
- German Perez-Suarez
- Nephrology Department, Hospital Universitario Insular de Las Palmas de Gran Canaria, Las Palmas, Canary Islands, Spain.
| | - Ma Isabel Luis Yanes
- Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| | | | | | - Víctor M García Nieto
- Pediatric Nephrology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
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6
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Laurer E, Grünberger J, Naidoo U, Lanzersdorfer R, Wimleitner M, Tischlinger K, Högler W. Recombinant human parathyroid hormone (1-84) replacement therapy in a child with hypoparathyroidism. Bone 2021; 144:115834. [PMID: 33359892 DOI: 10.1016/j.bone.2020.115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
First line conventional therapy of hypoparathyroidism comprises oral calcium and active vitamin D analogues. This approach may fail to correct hypocalcemia and hyperphosphatemia caused by the absence of parathyroid hormone and carries the risk of long-term complications including ectopic calcifications and renal damage. Full-length recombinant human parathyroid hormone (rhPTH[1-84]) is approved for the treatment of hypoparathyroidism in adults refractory to conventional therapy. To date, there is no data in children. Here, we report the successful use of rhPTH(1-84) in a 5-year old girl with hypoparathyroidism and concomitant chronic diarrhea manifesting as part of the autoimmune polyglandular syndrome type 1. Prior to starting rhPTH(1-84), the patient had been on conventional and later on rhPTH(1-34) continuous pump therapy. Conventional therapy failed to meet serum and urinary calcium target levels, whilst the pump therapy wasn't well tolerated and posed handling difficulties. Dose optimization for rhPTH(1-84) was informed by serum ionized calcium, spot urinary calcium-to-creatinine ratio and 24-hour urinary calcium excretion. Twice-daily subcutaneous injections of rhPTH(1-84) with a total dose of 3.35 μg/kg/d was well-tolerated, raised serum ionized calcium to target range (1.05-1.15 mmol/L) and normalized serum phosphate levels. Urinary calcium excretion was slightly above the recommended limit of 4 mg/kg/24 h, but improved compared to conventional therapy, with no evidence of nephrocalcinosis. Twice-daily administration stabilized serum calcium and phosphate levels compared to once-daily injections. rhPTH(1-84) treatment was well tolerated and the girl did not manifest any acute clinical complications of hypoparathyroidism throughout the entire observation period. Our experience with this case indicates that rhPTH(1-84) may be a physiological hormone replacement for managing hypoparathyroidism in children.
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Affiliation(s)
- Elisabeth Laurer
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria.
| | - Johanna Grünberger
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Uvistra Naidoo
- South African Tuberculosis Vaccine Institute, University of Cape Town, South Africa
| | - Roland Lanzersdorfer
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Marlene Wimleitner
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Katharina Tischlinger
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
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7
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Paccaud Y, Rios-Leyvraz M, Bochud M, Tabin R, Genin B, Russo M, Rossier MF, Bovet P, Chiolero A, Parvex P. Spot urine samples to estimate 24-hour urinary calcium excretion in school-age children. Eur J Pediatr 2020; 179:1673-1681. [PMID: 32388721 DOI: 10.1007/s00431-020-03662-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Urinary calcium/creatinine ratio (UCa/Cr) on a single spot urine sample is frequently used in children to evaluate calciuria, but its accuracy to estimate 24-h urinary calcium excretion (24hUCa) has not been properly assessed. We analyzed the correlation between UCa/Cr in various spot samples and 24hUCa among healthy children. A 24-h urine specimen and three spot urine samples (evening, first, and second morning) were collected in a convenience sample of children aged 6 to 16 years (n = 101). Measured 24hUCa was compared with UCa/Cr in each of the three spot samples. The ability of UCa/Cr to discriminate between children with and without hypercalciuria (calciuria > 4 mg/kg/24 h, 1 mmol/kg/24 h) and optimal timing of the spot sample were determined. Eighty-five children completed an adequate 24-h urine collection. Pearson correlation coefficients between the UCa/Cr on the spot sample and 24hUCa were 0.64, 0.71, and 0.52 for the evening, first, and second morning spot samples, respectively. Areas under the ROC curve were 0.90, 0.82, and 0.75, respectively, for the corresponding spot samples.Conclusion: The relatively strong correlation between 24hUCa and UCa/Cr in evening and first morning spot urine samples suggests that these spots could be preferred in clinical practice.Trial registration: ClinicalTrials.gov , NCT02900261, date of trial registration 14 September 2016. What is Known: •Urinary calcium/creatinine ratio on a single spot urine sample is frequently used as a proxy for 24-h urinary calcium excretion. •Correlation of these indicators, including the best timing for spot urine sampling, has not been properly assessed. What is New: •Relatively strong correlations were found between the calcium/creatinine ratio on a single spot urine sample and 24-h urinary calcium excretion in healthy children. •Evening and first morning spot samples had the highest correlation.
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Affiliation(s)
- Yan Paccaud
- Hospital Center of Valais Romand, Hospital of Valais, Avenue Grand-Champsec 80, 0041276034147, 1950, Sion, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Magali Rios-Leyvraz
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Murielle Bochud
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - René Tabin
- Hospital Center of Valais Romand, Hospital of Valais, Avenue Grand-Champsec 80, 0041276034147, 1950, Sion, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Genin
- Hospital Center of Valais Romand, Hospital of Valais, Avenue Grand-Champsec 80, 0041276034147, 1950, Sion, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michel Russo
- Hospital Center of Valais Romand, Hospital of Valais, Avenue Grand-Champsec 80, 0041276034147, 1950, Sion, Switzerland
| | - Michel F Rossier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Central Institute of Hospitals, Hospital of Valais, Sion, Switzerland
| | - Pascal Bovet
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Paloma Parvex
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol 2020; 35:383-397. [PMID: 30607567 DOI: 10.1007/s00467-018-4179-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the pediatric nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. OBJECTIVE The purpose of this review is to summarize the existing literature on the etiology and management of pediatric nephrolithiasis. RESULTS The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. CONCLUSIONS Pediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.
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Kompani F, Valavi E, Amuri P, Mohtasham N. Role of Calcium to Citrate Ratio in Predicting Stone Formation in Idiopathic Hypercalciuria Children (2-12 Years Old). J Ren Nutr 2018; 29:97-101. [PMID: 30322785 DOI: 10.1053/j.jrn.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 08/11/2018] [Accepted: 08/11/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Considering the predictive role of the relatively low urinary citrate for stone formation, especially in hypercalciuric patients, this study is aimed at comparing urine calcium to citrate (Ca/Cit) ratio in 3 groups of children, including patients with idiopathic hypercalciuria with and without renal stone as well as the healthy children. METHODS This study was carried out on 96 children (2 to 12 years old) referred to a pediatric nephrology clinic in the city of Ahvaz, Southwest Iran. All the children underwent renal ultrasonography, urinalysis, and measurement of random nonfasting urine Ca, Cr, and citrate. Those with secondary hypercalciuria, urinary tract malformations, and/or functional abnormalities of the gastrointestinal tract were excluded from the study. RESULTS The mean Ca/Cit. ratio (mg/mg) in the three groups, including children with hypercalciuric with and without renal stones and the healthy children (control group), was 0.44 ± 0.14, 0.39 ± 0.13, and 0.19 ± 0.08, respectively, which showed a significant difference (P < .001). There was also a significant difference in Ca/Cit ratio between the first and the control group by Tukey's range test (P < .001). Mean urinary Ca/Cit ratio in those with a positive family history of urolithiasis within three groups was 0.42 ± 0.17 and in those with a negative family history was 0.32 ± 0.16 (P = .013). Mean Ca/Cit. ratio (mg/mg) of 0.25 showed a sensitivity of 90.6% (confidence interval: 75.7-96.7%) and a specificity of 81.2% (confidence interval: 64.7-91.1%) to differentiate between the renal stone group and the control group. CONCLUSION High Ca/Cit ratio can predict stones formation in hypercalciuric patients, especially in those with a positive family history of urolithiasis. The present study found the cutoff level of 0.25 for Ca/Cit. ratio as the highest prognostic value for renal stone formation.
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Affiliation(s)
- Farshid Kompani
- Department of Pediatric Nephrology, Taleghani Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ehsan Valavi
- Department of Pediatric Nephrology, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Parisa Amuri
- Department of Pediatric Nephrology, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Mohtasham
- Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Furusawa EA, Esposito CSL, Honjo RS, Suzuki L, Leal GN, Kim CA, Schvartsman BGS. Diagnosis and management of systemic hypertension due to renovascular and aortic stenosis in patients with Williams-Beuren syndrome. Rev Assoc Med Bras (1992) 2018; 64:723-728. [DOI: 10.1590/1806-9282.64.08.723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 11/22/2022] Open
Abstract
SUMMARY AIM To describe the incidence, diagnosis, and management of systemic arterial hypertension related to renal artery stenosis in patients with Williams-Beuren syndrome. METHODS Sixty-five patients with Williams-Beuren syndrome were evaluated for hypertension. Enrolled patients underwent Doppler sonography of the renal arteries and Doppler echocardiography. Those with Doppler sonography-detected lesions or with normal Doppler sonography but severe hypertension underwent computed tomography or gadolinium-enhanced magnetic resonance angiography of the aorta and renal vessels. Patients needing vascular therapeutic intervention underwent conventional angiography. RESULTS Systemic arterial hypertension was diagnosed in 21/65 patients with Williams-Beuren syndrome (32%; 13 male) with a mean age of 13.9 years (5mo-20yrs). In 8/21 patients renovascular hypertension was detected. Angioplasty was unsuccessful in five patients with renal artery stenosis, requiring additional treatment. Doppler echocardiography showed cardiac abnormalities in 16/21 (76%) hypertensive patients. CONCLUSION Cardiac abnormalities and hypertension in patients with Williams-Beuren syndrome are common. Thus, thorough evaluation and follow-up are necessary to reduce cardiovascular risks and mortality of these patients
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García Nieto V, Sotoca Fernández J, O’Hagan M, Arango Sancho P, Luis Yanes MI. A family history of renal lithiasis in children diagnosed of urinary tract infection by Escherichia coli. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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García Nieto V, Sotoca Fernández J, O’Hagan M, Arango Sancho P, Luis Yanes MI. Historia familiar de litiasis renal en pacientes diagnosticados de infección del tracto urinario por Escherichia coli. An Pediatr (Barc) 2018; 88:204-208. [DOI: 10.1016/j.anpedi.2017.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/24/2022] Open
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13
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Wang J, Zheng X, Zhang L, Zhang Y, Xiong J, Cheng Y, Shi H, Qiu X, Zhou L, Sun X. The variation in urinary calcium levels in adult patients with fracture and surgical intervention. J Orthop Surg Res 2017; 12:123. [PMID: 28810891 PMCID: PMC5558773 DOI: 10.1186/s13018-017-0624-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022] Open
Abstract
Background Generally, a higher calcium diet is fed to fracture patients after surgery. However, recent studies have indicated that higher dietary calcium intakes increase the risk of urinary stones for fracture patients. Therefore, this study aimed to observe the variation in urinary calcium levels among fracture patients who underwent surgery, based on fracture type, fracture location, age and gender. Methods A total of 768 subjects were enrolled in this study from 2012 to 2015 and were divided into 2 groups: group A (fracture patients who underwent surgery) and group B (normal patients without fracture). Urine samples were collected for a 24-h period (24-h urine), at multiple specific time points before and after surgery for group A, or after hospitalisation for group B. Subsequently, urine calcium was detected and the changes were evaluated according to fracture location, fracture type, age and gender, as well as the distribution of hypercalciuria. Results Compared with group B, the level of urine calcium in group A significantly increased at different time points during the study period (P < 0.05). There were significant differences in the changes in urine calcium levels according to fracture location, fracture type and age, but not gender. Further, there were more patients with hypercalciuria in group A at the different time points, compared with group B. Conclusion Variation in urinary calcium among fracture patients that underwent surgery was of a regular pattern and hypercalciuria was also found in these patients. Therefore, a high-calcium diet and calcium supplements should be used with caution in this patient population.
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Affiliation(s)
- Junfei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xin Zheng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China
| | - Liming Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yifan Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Yixin Cheng
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Hongfei Shi
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xusheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Leqin Zhou
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xizhao Sun
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China. .,Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Ferré N, Rubio-Torrents C, Luque V, Closa-Monasterolo R, Grote V, Koletzko B, Socha P, Gruszfeld D, Langhendries JP, Sengier A, Verduci E, Escribano J. Influence of Feeding Types during the First Months of Life on Calciuria Levels in Healthy Infants: A Secondary Analysis from a Randomized Clinical Trial. ANNALS OF NUTRITION AND METABOLISM 2017; 70:132-139. [DOI: 10.1159/000468156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/18/2017] [Indexed: 11/19/2022]
Abstract
Background/Aims: Dietary factors can modify calciuria. We aim to investigate urinary calcium excretion in healthy infants according to their protein. Methods: Secondary data analysis from a randomized clinical trial where healthy term infants were randomized after birth to a higher (HP) or lower (LP) protein content formula that was consumed until age 1 year. A non-randomized group of breastfed (BF) infants was used for reference. Anthropometry, dietary intakes and calciuria (calcium/creatinine ratios) from spot urine samples were assessed at ages 3 and 6 months. At 6 months, the kidney volumes were assessed using ultrasonography, and the serum urea and creatinine levels were determined. Results: BF infants showed the highest calciuria levels, followed by the HP and the LP groups (p < 0.001 for all comparisons). Either protein intakes or formula types modulated the calciuria in linear regression models adjusted for other influencing dietary factors. The usual cut-off values classified 37.8% (BF), 16.8% (HP) and 4.9% (LP) of the infants as hypercalciuric. Conclusions: Feeding types during the first months of life affect calciuria, with BF infants presenting the highest levels. We propose new cut-off values, based on feeding types, to prevent the overestimation in hypercalciuria diagnoses among BF infants.
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Unilateral renal agenesis. New arguments about the genetic relationship between kidney malformations and urolithiasis. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Garcia Nieto V, Huertes Díaz B, Escribano Subias J, Alarcón Alacio MT, Gonzalez Rodríguez JD, Cabrera Sevilla JE, Peralta Aros C, Luis Yanes MI. [Unilateral renal agenesis. New arguments about the genetic relationship between kidney malformations and urolithiasis]. An Pediatr (Barc) 2016; 85:240-246. [PMID: 26669685 DOI: 10.1016/j.anpedi.2015.09.023] [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: 06/04/2015] [Revised: 08/12/2015] [Accepted: 09/07/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In few previous works, it has been reported that hypercalciuria is associated with some types of CAKUT, namely ureteropelvic junction obstruction, vesicoureteral reflux or simple renal cysts. In addition, one higher prevalence of hypercalciuria and/or urolithiasis has been described in their family members compared to the general population. This study was carried out to find out whether children with unilateral renal agenesis (URA) have these features previously described in other CAKUT types. METHODS In a descriptive and multicenter study we studied the prevalence of hypercalciuria, hypocitraturia and urolithiasis in 67 children (43 males and 24 females) with URA and their families. RESULTS The two metabolic anomalies that promote stone formation were observed in 26 children (38.8%), distributed as follows: hypercalciuria in 16, hypocitraturia in 9, and both hypercalciuria and hypocitraturia in 1. Eight children (11.9%) suffered renal colic during follow-up. Familial history of urolithiasis was found in 42/67 children (62.7%): in 12 of the first-degree relatives, in 15 of the second degree relatives and in 15 patients both in the first-degree as in their second degree relatives. In contrast, in historic control group, only in 28.1% of families at least one member had urolithiasis. CONCLUSION Our results show that the prevalence of hypercalciuria and/or hypocitraturia is greater in pediatric patients with URA than in the general population. Likewise, the prevalence of urolithiasis in the families of these children is also higher than that in the general population.
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Affiliation(s)
- Victor Garcia Nieto
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria Santa Cruz de Tenerife, España.
| | | | | | | | | | | | | | - Maria Isabel Luis Yanes
- Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria Santa Cruz de Tenerife, España
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17
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Velásquez-Forero F, Esparza M, Salas A, Medeiros M, Toussaint G, Llach F. Risk factors evaluation for urolithiasis among children. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:228-236. [PMID: 29421385 DOI: 10.1016/j.bmhimx.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The prevalence of pediatric urolithiasis varies from 0.01-0.03%. Urolithiasis may be caused by anatomical, metabolic and environmental factors. Recurrence varies between 16 to 67%, and it is frequently associated with metabolic abnormalities. The objective of the present work was the identification of risk factors that promote urolithiasis in a child population. METHODS This study included 162 children with urolithiasis and normal renal function (mean age 7.5 years). Risk factors were investigated in two stages. In the first stage, 24-hour urine, and blood samples were analyzed to assess metabolic parameters and urinary tract infection. During the second stage, the effect of calcium restriction and a calcium load on renal Ca excretion were evaluated. Data were statistically analyzed. RESULTS Urolithiasis was observed in 0.02% of children, 50% of them with family history of urinary stones. There were multiple risk factors for urolithiasis including hypocitraturia (70%), hypomagnesuria (42%), hypercalciuria (37%; in 11/102 was by intestinal hyperabsorption, in 13/102 was unclassified. Ca resorption or renal Ca leak were not detected). We also detected alkaline urine (21%), systemic metabolic acidosis (20%), urinary infections (16%), nephrocalcinosis with urolithiasis (11%), oliguria (8%), urinary tract anomalies, hyperuricosemia and hypermagnesemia (7% each one), hypercalcemia (6%), hyperoxaluria (2%) and hypercystinuria (0.61%). CONCLUSIONS Hypocitraturia and hypomagnesuria were the most frequent risk factors associated with urolithiasis, followed by hypercalciuria. High PTH values were excluded. Children presented two or more risk factors for urolithiasis.
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Affiliation(s)
- Francisco Velásquez-Forero
- Laboratorio de Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Mariela Esparza
- Laboratorio de Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Alejandro Salas
- Laboratorio de Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez; Servicio de Nefrología, Hospital General de México, Mexico City, Mexico
| | - Mara Medeiros
- Laboratorio de Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Georgina Toussaint
- Laboratorio de Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Francisco Llach
- Former Director of Clinical Nephrology and Hypertension. Georgetown University Hospital, Washington, DC, USA
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18
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Cambareri GM, Kovacevic L, Bayne AP, Giel D, Corbett S, Schurtz E, Sukhu T, Chiang G. National multi-institutional cooperative on urolithiasis in children: Age is a significant predictor of urine abnormalities. J Pediatr Urol 2015; 11:218-23. [PMID: 26119451 DOI: 10.1016/j.jpurol.2015.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pediatric nephrolithiasis is a growing problem and prior studies have shown the greatest increase in nephrolithiasis in the adolescent population. Metabolic abnormalities have historically been cited as the primary cause of pediatric nephrolithiasis; however, dietary and other factors such as obesity have also been studied with mixed results. OBJECTIVE We reviewed the charts of pediatric patients with a history of nephrolithiasis to determine the number and types of metabolic abnormalities present on 24-h urine analysis. STUDY DESIGN We retrospectively reviewed the charts of all pediatric patients with a history of nephrolithiasis from 1999-2013 across four different institutions. The subjects were excluded if they had a history of spina bifida, neurogenic bladder, cerebral palsy, isolated bladder stones, or if they were on medical therapy for nephrolithiasis before the first 24-h urine collection. RESULTS There were 206 subjects included in the analysis with an average age of 13 (±3.9) years. The patients were stratified into two age groups based on an apparent bimodal distribution of metabolic abnormalities, ≤10 years and >10 years of age. Metabolic abnormalities were present in 130 children (63.1%) and there was a difference between the groups, with children ≤10 years more likely to have a metabolic abnormality compared with those >10 years of age (75% vs. 60.6%, p = 0.0443) on univariate analysis. In children ≤10 years hypercalciuria was the most common disorder present (48.4%), and in children >10 years hypocitraturia was the most common disorder present (26.1%). Children ≤10 years of age were more likely to have normal volume (p = 0.006), elevated urinary oxalate (p = 0.0351), elevated urinary calcium (p < 0.001), elevated supersaturation of calcium phosphate (p < 0.001), and elevated supersaturation of calcium oxalate (p = 0.002). On multivariate analysis, children ≤10 years of age were more likely to have normal volume, hyperoxaluria, elevated supersaturation of calcium phosphate and a trend towards hypercalciuria (Table). DISCUSSION Our study reveals that younger children are more likely to have a metabolic abnormality present on 24-h urine analysis. This has important implications when deciding on treatment options, with younger children potentially requiring more aggressive management with medical therapy. Older children were more likely to have low urinary volume and their most common metabolic abnormality was hypocitraturia. Although dietary factors have not been established as the definitive reason behind the rising incidence of nephrolithiasis in the adolescent population, older children may benefit more from diet modification with a strong focus on increasing volume intake. CONCLUSION We found differences in younger compared with older age groups in terms of the number and types of metabolic disorders present. Children ≤10 years of age were more likely to have a metabolic disorder including elevations in calcium, oxalate and supersaturation of calcium phosphate, while children >10 years of age were more likely to have low urinary volume. These differences have important implications for future investigative studies on the rising incidence as well as the best course of treatment for children with nephrolithiasis.
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Affiliation(s)
| | - Larisa Kovacevic
- Children's Hospital of Michigan, Department of Urology, Detroit, MI, USA.
| | - Aaron P Bayne
- Oregon Health Sciences University, Department of Urology, Portland, OR, USA.
| | - Dana Giel
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Division of Pediatric Urology, Memphis, TN, USA.
| | - Sean Corbett
- University of Virginia, Department of Urology, Charlottesville, VA, USA.
| | - Elleson Schurtz
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Division of Pediatric Urology, Memphis, TN, USA.
| | - Troy Sukhu
- University of Virginia, Department of Urology, Charlottesville, VA, USA.
| | - George Chiang
- UCSD Department of Urology, Rady Children's Specialists of San Diego, San Diego, CA, USA.
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Malaki M. The comparison of ultrasound and non-contrast helical computerized tomography for children nephrolithiasis detection. Urol Ann 2014; 6:309-13. [PMID: 25371607 PMCID: PMC4216536 DOI: 10.4103/0974-7796.140991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/11/2013] [Indexed: 11/15/2022] Open
Abstract
AIMS Nephrolithiasis is less common in children than adults, but its diagnosis and management in children may be more perplexing. In this article, we compare two imaging ultrasound (US) and non-contrast helical computerized tomography (CT) for diagnosis of nephrolithiasis. SUBJECTS AND METHODS A total of 20 children who diagnosed as nephrolithiasis by US were imaged simultaneously by non-contrast helical CT. Their history like as family history in first and second degree relatives and urine analysis for hematuria and urine randomly calcium to creatinine ratio was obtained. All data analyzed by χ(2) and Mann-Whitney U-test in SPSS 16 and P < 0.05 was considered to be significant. RESULTS Out of 20 cases, only 5 cases diagnosed as nephrlithiasis by US were confirmed by CT method 2 out of 20 cases had another extrarenal origin for their complaint who diagnosed wrongly as nephrolithiasis by US. Stone size based of US that was confirmed by CT method was larger 4.6 ± 1.5 (minimum 3 max 6 mm) than non-confirmed ones 2.3 ± 0.7 mm (P 0.002). Hematuria occurred more in correct diagnosed compared with misdiagnosed (P 0.005). Positive family history and urine calcium ratio was not differed between two groups. CONCLUSIONS Non contrast helical CT is essential to confirm of nephrolithiasis and other extrarenal origin of complaints, which diagnosed wrongly as nephrolithiasis in children. Stone size and presence of hematuria are two major factors for right diagnosis of nephrolithiasis as US method but Urine calcium excretion ratio or positive family history cannot be predictive as this study.
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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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Vijayakumar M, Nageswaran P, Tirukalathi OM, Sudha E, Priyadarshini S. Descriptive study of clinical profile and benefit of therapy in childhood hypercalciuria. Int J Nephrol Renovasc Dis 2014; 7:69-73. [PMID: 24532972 PMCID: PMC3923610 DOI: 10.2147/ijnrd.s53541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clinical, biochemical, and ultrasonographic findings in 91 consecutive children presenting with hypercalciuria were analyzed along with the results of treatment to determine the clinical profile of hypercalciuria and its outcome. Hypercalciuria was common in children aged 1-5 years (39.6%), and hematuria was the most frequent symptom. There was no significant difference between 24-hour urinary calcium and random urinary calcium/creatinine ratio values between males and females. The random urinary calcium/creatinine ratio was found to be useful for screening and also for documenting the benefit of therapy. The children were essentially treated with thiazides, and the majority showed a good response, with a good overall outcome on follow-up.
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Affiliation(s)
- Mahalingam Vijayakumar
- Department of Pediatric Nephrology and Pediatrics, Mehta Children's Hospital, Chennai, Tamilnadu, India
| | - Prahlad Nageswaran
- Department of Pediatric Nephrology and Pediatrics, Mehta Children's Hospital, Chennai, Tamilnadu, India
| | - O Manimegalai Tirukalathi
- Department of Pediatric Nephrology and Pediatrics, Mehta Children's Hospital, Chennai, Tamilnadu, India
| | - Ekambaram Sudha
- Department of Pediatric Nephrology and Pediatrics, Mehta Children's Hospital, Chennai, Tamilnadu, India
| | - Shweta Priyadarshini
- Department of Pediatric Nephrology and Pediatrics, Mehta Children's Hospital, Chennai, Tamilnadu, India
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22
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Risk factors for urinary stones in healthy schoolchildren with and without a family history of nephrolithiasis. Pediatr Nephrol 2013; 28:639-45. [PMID: 23212561 DOI: 10.1007/s00467-012-2368-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. METHODS Urine samples were obtained from 184 children aged 5-12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. RESULTS Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. CONCLUSIONS We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis.
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Holmlund-Suila E, Viljakainen H, Hytinantti T, Lamberg-Allardt C, Andersson S, Mäkitie O. High-dose vitamin d intervention in infants--effects on vitamin d status, calcium homeostasis, and bone strength. J Clin Endocrinol Metab 2012; 97:4139-47. [PMID: 22933541 DOI: 10.1210/jc.2012-1575] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Guidelines in Finland recommend 10 μg of vitamin D3 daily for all infants. Recent observations suggest that this may be insufficient to maintain optimal serum 25-hydroxyvitamin D (S-25-OHD). OBJECTIVE The aim of the study was to evaluate effects of various vitamin D doses and determine a dose ensuring S-25-OHD of at least 80 nmol/liter in infants without signs of vitamin D excess. DESIGN We conducted a randomized double-blind intervention study. Cord blood was obtained at birth for S-25-OHD; 113 infants were randomized to receive vitamin D3 10, 30, or 40 μg/d from age 2 wk to 3 months. SETTING An investigator-initiated study was performed in a single maternity hospital in Helsinki, Finland. MAIN OUTCOME MEASURES S-25-OHD, calcium homeostasis, and skeletal characteristics were evaluated with peripheral quantitative computed tomography at age 3 months. RESULTS Baseline S-25-OHD was similar in all three groups (median, 53 nmol/liter). At 3 months, the mean S-25-OHD values were 88, 124, and 153 nmol/liter, and the minimum values were 46, 57, and 86 nmol/liter in the groups receiving 10, 30, and 40 μg (ANOVA; P < 0.001). No hypercalcemia occurred; plasma calcium, serum PTH, and urine calcium excretion was similar between the groups. Peripheral quantitative computed tomography showed a trend toward larger tibial total bone and cortical bone area with higher vitamin D doses. CONCLUSION Vitamin D3 supplementation with up to 40 μg/d from age 2 wk to 3 months was safe and caused no hypercalcemia or hypercalciuria. The 40-μg dose maintained S-25-OHD above 80 nmol/liter in all infants. More extensive and longer intervention studies are necessary to assess long-term effects.
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Affiliation(s)
- Elisa Holmlund-Suila
- Pediatric Endocrinology and Metabolic Bone Diseases, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, P.O. Box 281, FIN-00029 HUS, Helsinki, Finland
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Plasma and urinary levels of cytokines in patients with idiopathic hypercalciuria. Pediatr Nephrol 2012; 27:941-8. [PMID: 22223141 DOI: 10.1007/s00467-011-2094-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 12/02/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Recent studies suggest that cytokines modulate bone turnover. Idiopathic hypercalciuria (IH) seems to be associated with bone mineral loss. Therefore, the aim of this study was to assess cytokines involved in bone turnover in patients with IH. METHODS Plasma and spot-urine levels of interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein (MCP-1) were measured in 70 children and adolescents with IH and in 37 healthy controls. Patients with IH were subdivided according to their calciuria at the time of sample collection: ≥4 mg/kg/day (persistent IH, n=27) and below 4 mg/kg/day (controlled IH, n=43). Cytokines were determined by enzyme-linked immunoassay. RESULTS Plasma and urinary concentrations of IL-1β, IL-6, IL-8, and TNF-α were undetectable in all groups. No differences were found between controlled and persistent hypercalciuria for plasma and urinary levels of MCP-1 and TGF-β1. On the other hand, MCP-1 levels were significantly higher in both subgroups of IH in comparison to healthy controls. Furthermore, urinary MCP-1 levels of IH patients correlated positively with bone mineral content (p=0.013). CONCLUSION Although cytokine measurements did not allow the differentiation between persistent and controlled IH, our findings suggest that MCP-1 might play a role in patients with IH.
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Baştuğ F, Düşünsel R. Pediatric urolithiasis: causative factors, diagnosis and medical management. Nat Rev Urol 2012; 9:138-46. [PMID: 22310215 DOI: 10.1038/nrurol.2012.4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Childhood urolithiasis is associated with considerable morbidity and recurrence. Many risk factors--including those metabolic, genetic, anatomic, dietary and environmental in nature--have been identified in children with urinary tract calculi. As pediatric urolithiasis with a metabolic etiology is the most common disease, evaluating the metabolic risk factors in patients is necessary to both effectively treat current stones and prevent recurrence. We discuss causative risk factors of pediatric urolithiasis, as well as the diagnostic and therapeutic approaches.
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Affiliation(s)
- Funda Baştuğ
- Erciyes University Medical Faculty, Department of Pediatric Nephrology, Talas Street, 38039 Kayseri, Turkey.
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Effect of thiazides on bone mineral density in children with idiopathic hypercalciuria. Pediatr Nephrol 2012; 27:261-8. [PMID: 21874585 DOI: 10.1007/s00467-011-1987-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 07/20/2011] [Accepted: 08/01/2011] [Indexed: 02/07/2023]
Abstract
To determine the effect of thiazide treatment on bone mineral density (BMD) in children with idiopathic hypercalciuria (IH) and osteopenia, we reviewed the case notes of 22 children aged 11.7 ± 2.7 years diagnosed with IH and osteopenia who had received thiazides for 2.4 years. The data on this group were compared with those of 32 IH children with osteopenia aged 11.2 ± 2.7 years who had not received thiazide treatment. By the end of the follow-up period, the z-BMD had improved spontaneously in 23 of the 32 control children (72%) and in 12 of the 22 patients on thiazides (54%). Although treated patients had a higher body mass index (BMI) and a higher BMD following treatment, the differences became statistically negligible when these parameters were expressed as z-BMD or as bone mineral apparent density (BMAD). In contrast, within the control group, there were significant differences in BMAD and z-BMD at the end of the follow-up. Patients who had an improved z-BMD at the end of the treatment also showed an increase in their BMI. Based on these results, we conclude that thiazide treatment does not improve the z-BMD in children with IH. More than half of the children suffering from IH enrolled in our study showed a spontaneous improvement in their z-BMD, which was more evident when the initial BMAD was not low and when their BMI increased during the follow-up period.
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Jones AN, Blank RD, Lindstrom MJ, Penniston KL, Hansen KE. Adjustment for body mass index and calcitrophic hormone levels improves the diagnostic accuracy of the spot urine calcium-to-creatinine ratio. Osteoporos Int 2010; 21:1417-25. [PMID: 19760060 PMCID: PMC3065296 DOI: 10.1007/s00198-009-1058-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 08/18/2009] [Indexed: 11/25/2022]
Abstract
SUMMARY Providers diagnose hypercalciuria using a 24-hour or random urine samples. We compared calcium measurements from paired 24-hour and morning urine samples; measurements correlated poorly. We developed a formula to correct random urine calcium levels. Corrected levels showed excellent agreement with 24-hour measurements. Until validation, providers should diagnose hypercalciuria using 24-hour tests. INTRODUCTION Hypercalciuria is a risk factor for osteoporosis and nephrolithiasis. The 24-hour urine calcium (24HUC) measurement is the gold standard to diagnose hypercalciuria, but the spot urine calcium-to-creatinine ratio (SUCCR) is more convenient. Although authors claim they are interchangeable, we observed inconsistencies during the conduct of a clinical trial. Therefore, we systematically evaluated agreement between the tests. METHODS During a 28-inpatient calcium absorption studies in 16 postmenopausal women, we simultaneously collected paired fasting morning and 24-hour urine specimens. RESULTS We found moderate correlation between paired SUCCR and 24HUC specimens (r = 0.57, p = 0.002), but the SUCCR underestimated 24HUC by a mean of 83 mg (Bland-Altman). We diagnosed hypercalciuria (24HUC >250 mg) in eight specimens using the 24HUC, but only in two specimens using the SUCCR (25% sensitivity). We developed a regression model to predict 24HUC using SUCCR, parathyroid hormone, body mass index, and 1,25(OH)(2)D. The model improved diagnostic sensitivity to 100% and decreased Bland-Altman bias of the SUCCR to +0.06 mg/kg/24-hour. CONCLUSIONS We conclude that the SUCCR underestimates urine calcium loss and does not reliably diagnose hypercalciuria. A formula derived from multivariate regression incorporating other readily measurable variables greatly improved the SUCCR's accuracy. Future studies must verify this correction before clinical implementation.
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Affiliation(s)
- Andrea N. Jones
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 600 Highland Avenue, Madison, Wisconsin 53792
- University of Wisconsin Osteoporosis Clinical Center & Research Program, 2870 University Avenue Suite 100, Madison, Wisconsin 53705
| | - Robert D. Blank
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 600 Highland Avenue, Madison, Wisconsin 53792
- University of Wisconsin Osteoporosis Clinical Center & Research Program, 2870 University Avenue Suite 100, Madison, Wisconsin 53705
- William S. Middleton Veterans Affairs Medical Center GRECC Service, 2500 Overlook Terrace, Madison, WI 53705
| | - Mary J. Lindstrom
- University of Wisconsin Department of Biostatistics and Medical Informatics, 600 Highland Avenue, Madison, Wisconsin 53792
| | - Kristina L. Penniston
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, 600 Highland Avenue, Madison, Wisconsin 53792
| | - Karen E. Hansen
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 600 Highland Avenue, Madison, Wisconsin 53792
- University of Wisconsin Osteoporosis Clinical Center & Research Program, 2870 University Avenue Suite 100, Madison, Wisconsin 53705
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Oliveira da Costa Mattos RDC, Xavier EC, Domingos Mainenti HR, Mitri Nogueira S, Ribeiro de Carvalho MA, Ramos Moreira MDF, Vargas de Carvalho LB, Tabalipa M, Borges R, Malizia Alves MDF. Evaluation of calcium excretion in Brazilian infantile and young population environmentally exposed to lead. Hum Exp Toxicol 2009; 28:567-75. [PMID: 19737813 DOI: 10.1177/0960327109102804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lead exposure is an important issue in the research of several toxic effects resulting from the biochemical interaction between this metal and the organism. Calcium is a fundamental mineral for the maintenance of the organism homeostasis where there is interaction between lead and calcium in metabolic pathways. Environmental lead exposure by verifying the usefulness and applicability of urinary calcium/creatinine ratio (UCa/Cr) in this context was evaluated. This was an extensive socio-demographic study of the nutritional profile, lead exposure biomarkers in blood and the urine and UCa/Cr ratio. The children studied were from a low socio-economic group characterized by unsatisfactory nutritional diet. Lead environmental exposure was shown by biomarkers, with UCa/Cr ratio having positive and significant correlations with both lead and delta-aminolevulinic acid in urine (ALA-U), without colinearity diagnosis. There was a strong association between calcium excretion and lead exposure as a result of linear regression construction models. In children, lead increases calcium excretion which is an additional risk to infantile health. Urinary calcium/creatinine ratio may be a useful tool in the biological monitoring of lead exposure and health promotion programs.
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Affiliation(s)
- Rita de Cássia Oliveira da Costa Mattos
- Laboratory of Toxicology, Workers' Health and Human Ecology Studies Center, Sergio Arouca National Public Health School, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
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García-Nieto V, Navarro JF, Luis-Yanes MI, López-Méndez M, García-Rodríguez V. Hypercalciuria in pediatric patients with ureteropelvic junction obstruction is of genetic origin. ACTA ACUST UNITED AC 2009; 41:144-8. [PMID: 17454954 DOI: 10.1080/00365590600991201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Genitourinary tract malformations are associated with urolithiasis. Hypercalciuria has been described in children with ureteropelvic junction obstruction (UPJO), although the etiology of this metabolic abnormality remains unknown. This study was conducted to find out whether children with UPJO have a higher prevalence of hypercalciuria and whether their family members are affected by hypercalciuria and/or urolithiasis. MATERIAL AND METHODS We studied the prevalence of hypercalciuria and urolithiasis in 27 children (14 males, 13 females) with UPJO and their parents. RESULTS One patient had a history of renal colic, whereas imaging studies showed macroscopic renal lithiasis in two patients and calyceal microlithiasis in four. Hypercalciuria was found in 17/27 children (63%), 15 of whom (88%) had a familial history of urolithiasis: seven families in first-degree relatives, six in second-degree relatives and two in other relatives. Concerning the 10 children without hypercalciuria, seven of them (70%) had a family history of urolithiasis: four in first-degree relatives and three in second-degree relatives. The prevalences of both urolithiasis and hypercalciuria were not influenced by gender. CONCLUSIONS Urolithiasis is associated with hypercalciuria in patients with UPJO. In accordance with previous data, our results show that the prevalence of hypercalciuria is greater in pediatric patients with UPJO than in the general population. Likewise, the prevalence of urolithiasis in the families of these children is also higher than that in the general population. Hypercalciuria was inherited as an autosomal dominant trait.
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Affiliation(s)
- Víctor García-Nieto
- Pediatric Nephrology Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain.
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Abstract
PURPOSE OF REVIEW In this review, recent advances in the epidemiology, genetics, clinical associations and management of idiopathic hypercalciuria will be discussed. RECENT FINDINGS A significant genetic contribution exists in the pathophysiology of hypercalciuria. Although several candidate genes and genetic alterations have been proposed, identification of precise gene(s) responsible remains elusive. Decreased bone density has been increasingly associated with hypercalciuria. Recent publications have suggested that bisphosphonates may play a role in the management in patients in whom both hypercalciuria and decreased bone density are present. SUMMARY Idiopathic hypercalciuria is a common disorder in children and can present with a range of clinical presentations such as hematuria, voiding dysfunction, flank pain, abdominal pain, nephrolithiasis, urinary tract infection and decreased bone mineral density. Dietary modifications are often sufficient in the management of hypercalciuria. If the symptoms persist or a rare monogenic disorder is present, consideration should be given to medical treatment with a thiazide diuretic and/or citrate therapy.
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The metabolic etiology of urolithiasis in Turkish children. Int Urol Nephrol 2009; 41:453-60. [PMID: 19184515 DOI: 10.1007/s11255-008-9513-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
Abstract
Pediatric urolithiasis is an endemic disease, especially in certain developing regions of the world, such as the Far East, and to a certain extent the Middle East and Turkey. The aim of the study is to determine the metabolic etiology and the prevalence of formation of urinary calculi in Turkish pediatric patients with urolithiasis. Seventy-two pediatric patients diagnosed as having urolithiasis were studied from 1999-2005 in Dr. Behcet Uz Child Disease and Surgery Education and Research Hospital Nephrology Department, Izmir, according to their presenting signs and clinical and laboratory findings. The other necessary tests were also applied to detect the etiology of the calculi formation. Of the 72 patients, 50 (69.4%) were male and 22 (30.6%) were female, with ages ranging from 2 to 168 months (mean age 72 +/- 35.7 months), and the male-to-female ratio of patients was 2.3. Twenty-four (33%) of them were diagnosed as having metabolic urolithiasis, 21 (30%) anatomic, 19 (26%) infectious and 8 (11%) idiopathic. The age at which urolithiasis was first diagnosed was found to be low in the metabolic and anatomic etiology groups (P = 0.028). Thirteen patients (18%) with urolithiasis were known to have a family history of stone disease, and in all of them metabolic etiology was considered to be the reason (P < 0.001). In all of the groups, the localization of the stone was found to be the upper urinary system most of the time, and in 17 (24%) with bilateral multiple stones, the etiology was found to be metabolic (P < 0.001). All of the patients were followed up for 3-72 months (mean 29.2 +/- 13.7 months), and four of them (5.5%) had recurrences. In order to prevent renal damage and recurrences in pediatric patients with urolithiasis in Turkey in whom the etiology is mostly metabolic, the illnesses must be investigated very cautiously, and their early diagnosis and treatment modalities must be considered.
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Hypercalciuria revisited: one or many conditions? Pediatr Nephrol 2008; 23:503-6. [PMID: 17943325 DOI: 10.1007/s00467-007-0574-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/02/2007] [Accepted: 07/03/2007] [Indexed: 10/22/2022]
Abstract
Idiopathic hypercalciuria is a defect occurring in 5-10% of the general population and most commonly detected in patients with calcium kidney stones or osteoporosis. Although high-penetrance autosomal dominant inheritance cannot be ruled out, hypercalciuria is probably a polygenic phenomenon. Findings obtained in monogenic disorders characterized by renal calcium stones, and/or hypercalciuria, and/or nephrocalcinosis, have suggested a number of genes as candidate genes in the pathogenesis of idiopathic hypercalciuria, i.e. soluble adenylate cyclase, calcium sensing receptor, vitamin D receptor and 1-alpha hydroxylase, sodium-phosphate co-transporter-2, claudin-16, chloride channel 5, etc. All the genetic findings obtained so far do not support the idea of different types of idiopathic hypercalciuria, i.e. absorptive, renal, and resorptive. On the contrary, they support clinical observations, which suggest idiopathic hypercalciuria as a single disorder characterized by altered calcium transport in the intestine, kidney and bone, due to various different combinations of multiple genetic and dietary players.
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Abstract
PURPOSE OF REVIEW Finding blood or protein in the urine of a patient can be the source of immense anxiety. The list of diseases that result in these findings is quite long. Thus, many pediatricians believe that an exhaustive investigation is necessary to be certain of the cause. The review will discuss the major causes of hematuria and proteinuria in the pediatric population, and discuss a rational approach to the evaluation of these conditions. RECENT FINDINGS A number of recent studies have examined the results of mass screenings of school-age children and the final outcome of examination of children with hematuria and/or proteinuria. Most children with either isolated hematuria or isolated proteinuria had benign disease processes. Children with combined hematuria and proteinuria had a higher prevalence of significant kidney disease. SUMMARY The urinalysis combined with the history and physical examination should indicate the cause of hematuria and proteinuria in most cases. Significant renal disease can be ruled out with a minimal amount of work-up in most patients. The presence of hematuria and proteinuria together significantly increases the likelihood of significant renal disease and should prompt a referral to a specialist.
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Vezzoli G, Soldati L, Gambaro G. Update on primary hypercalciuria from a genetic perspective. J Urol 2008; 179:1676-82. [PMID: 18343451 DOI: 10.1016/j.juro.2008.01.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE This review provides a brief update on genetic studies of primary hypercalciuria. We consider their possible implications for the pathogenesis and complications of primary hypercalciuria. MATERIALS AND METHODS Using the PubMed, MEDLINE and Scopus databases we reviewed the literature on pathogenesis and the complications of hypercalciuria, giving particular attention to genetic studies in humans. RESULTS Primary hypercalciuria is a defect occurring in 5% to 10% of the general population and it is most commonly detected in patients with calcium kidney stones or osteoporosis. In children it is associated with hematuria, renal stones or nocturnal enuresis. Although high penetrance, autosomal dominant inheritance cannot be ruled out, hypercalciuria is probably a polygenic disorder. A number of genes have been suggested as candidates in the pathogenesis of common idiopathic calcium nephrolithiasis and hypercalciuria, ie soluble adenylate cyclase, calcium sensing receptor, vitamin D receptor, chloride channel-5, sodium-phosphate cotransporter-2 and claudin-16. These genes may also have a role in complications of hypercalciuria. CONCLUSIONS The classic distinction among absorptive, renal and resorptive hypercalciuria seems insufficient to explain the many cellular and tissue modifications observed in patients with primary hypercalciuria. The condition seems to be a separate disorder, characterized by altered calcium transport in the intestine, kidney and bone, and caused by various combinations of multiple genetic and dietary changes.
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Affiliation(s)
- Giuseppe Vezzoli
- Nephrology Unit, San Raffaele Scientific Institute, Milan, Italy.
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35
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Urinary Reference Values for Stone Risk Factors in Children. J Urol 2008; 179:290-4; discussion 294. [DOI: 10.1016/j.juro.2007.08.163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Indexed: 11/19/2022]
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Peterson JM, Butani L. Determinants of urinary calcium and uric acid excretion in children after renal transplantation. Pediatr Transplant 2007; 11:716-20. [PMID: 17910647 DOI: 10.1111/j.1399-3046.2007.00729.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HC and HU predispose healthy children to develop hematuria and nephrolithiasis. The natural history of HC and HU has not been studied in renal transplant recipients who may be at greater risk of complications. Our study investigated the prevalence of HC and HU after Tx and determined independent predictors of urinary calcium and uric acid excretion. Twenty-five pediatric transplant patients were studied between one and 12 months after Tx. Demographic data and measurements of the random Uca/cr and uric acid excretion were collected. Multivariable regression analyses were used. The median age of the patients was 10.6 yr. The prevalence of HC and HU was 20% each at one month. At 12 months, 20% had HC and 13% had HU. There were no predictors for HC; for HU, the only predictor was systolic hypertension (p = 0.03). Our data demonstrate a high prevalence of HU and HC in pediatric renal Tx recipients. The long-term clinical implication of these metabolic abnormalities remains to be elucidated in prospective trials.
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Affiliation(s)
- J M Peterson
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA 95817, USA
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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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Srivastava T, Alon US. Pathophysiology of hypercalciuria in children. Pediatr Nephrol 2007; 22:1659-73. [PMID: 17464515 PMCID: PMC6904412 DOI: 10.1007/s00467-007-0482-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 03/11/2007] [Accepted: 03/12/2007] [Indexed: 12/17/2022]
Abstract
Urinary excretion of calcium is the result of a complex interplay between three organs-namely, the gastrointestinal tract, bone, and kidney-which is finely orchestrated by multiple hormones. Hypercalciuria is believed to be a polygenic trait and is influenced significantly by diet. This paper briefly reviews calcium handling by the renal tubule in normal and in hereditary disorders as it relates to the pathophysiology of hypercalciuria. The effects of dietary sodium, potassium, protein, calcium, and phosphate on calcium excretion, and the association of hypercalciuria with bone homeostasis is discussed, leading to recommendations on means to address excessive urinary calcium excretion.
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Affiliation(s)
- Tarak Srivastava
- Section of Nephrology, Bone and Mineral Disorder Clinic, The Children’s Mercy Hospital and Clinics, University of Missouri, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Uri S. Alon
- Section of Nephrology, Bone and Mineral Disorder Clinic, The Children’s Mercy Hospital and Clinics, University of Missouri, 2401 Gillham Road, Kansas City, MO 64108 USA
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Ammenti A, Neri E, Agistri R, Beseghi U, Bacchini E. Idiopathic hypercalciuria in infants with renal stones. Pediatr Nephrol 2006; 21:1901-3. [PMID: 16947030 DOI: 10.1007/s00467-006-0259-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
In children older than 2 years, hypercalciuria is the most common metabolic cause of renal stones. In infants, its prevalence is not well established. Since 1990, we observed five infants in whom renal stones or microcalculi were diagnosed between the age of 5 and 19 months. One of them was lost to follow up. In the present report, we describe the four patients who underwent metabolic evaluation and in whom idiopathic hypercalciuria (IH) was diagnosed. We conclude that IH is a frequent cause of microcalculi and renal stones in infants, and a screen for this condition is warranted in this age group.
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Affiliation(s)
- Anita Ammenti
- Department of Pediatrics, University of Parma, Parma, Italy
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Abstract
Metabolic bone disease in children includes many hereditary and acquired conditions of diverse etiology that lead to disturbed metabolism of the bone tissue. Some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs. Some of these disorders are rare, but some present public health concerns (for instance, rickets) that have been well known for many years but still persist. The most important clinical consequences of bone metabolic diseases in the pediatric population include reduced linear growth, bone deformations, and non-traumatic fractures leading to bone pain, deterioration of motor development and disability. In this article, we analyze primary and secondary osteoporosis, rickets, osteomalacia (nutritional and hereditary vitamin D-dependent, hypophosphatemic and that due to renal tubular abnormalities), renal osteodystrophy, sclerosing bony disorders, and some genetic bone diseases (hypophosphatasia, fibrous dysplasia, skeletal dysplasia, juvenile Paget disease, familial expansile osteolysis, and osteoporosis pseudoglioma syndrome). Early identification and treatment of potential risk factors is essential for skeletal health in adulthood. In most conditions it is necessary to ensure an appropriate diet, with calcium and vitamin D, and an adequate amount of physical activity as a means of prevention. In secondary bone diseases, treatment of the primary disorder is crucial. Most genetic disorders await prospective gene therapies, while bone marrow transplantation has been attempted in other disorders. At present, affected patients are treated symptomatically, frequently by interdisciplinary teams. The role of exercise and pharmacologic therapy with calcium, vitamin D, phosphate, bisphosphonates, calcitonin, sex hormones, growth hormone, and thiazides is discussed. The perspectives on future therapy with insulin-like growth factor-1, new analogs of vitamin D, strontium, osteoprotegerin, and calcimimetics are presented.
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Penido MGMG, Lima EM, Souto MFO, Marino VSP, Tupinambá ALF, França A. Hypocitraturia: a risk factor for reduced bone mineral density in idiopathic hypercalciuria? Pediatr Nephrol 2006; 21:74-8. [PMID: 16252112 DOI: 10.1007/s00467-005-2035-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Revised: 06/13/2005] [Accepted: 06/15/2005] [Indexed: 01/27/2023]
Abstract
UNLABELLED The association between idiopathic hypercalciuria (IH) and reduced bone mineral density (BMD) has been described in adults and children. Frequently, hypocitraturia (HC) is an associated condition. To determine the effect that HC may have on bone metabolism of these patients, we studied 88 children with IH at diagnosis, divided into the following groups: group 1-44 (50%) patients with associated HC; group 2-44 (50%) patients without HC; group 3 (29 subjects), a healthy control group. Urinary and blood electrolytes, as long as urinary N-telopeptide, were measured. Lumbar spine (L2-L4) and femoral neck bone mineral density (BMD) and bone mineral content (BMC) were measured by dual energy X-ray absorptiometry. There was no difference in age between the three groups (P=0.80), but weight, height, body mass index, and bone age were lower (P<0.01) and serum intact parathyroid hormone (iPTH) was higher (P<0.05) in group 1 than in groups 2 and 3. N-telopeptide, measured in urine, did not differ between groups. The following bone densitometry parameters: lumbar spine BMC, BMC adjusted for height (BMCh), BMC adjusted for width of vertebrae (BMCw) and BMD, as well as femoral neck BMD, were significantly lower in group 1 than in groups 2 and 3 (P<0.01). When we corrected densitometry parameters for height, BMC was lower in group 1 and not in group 2 when compared with controls. CONCLUSIONS Children with IH and associated HC may have a higher risk of bone mass loss and consequent osteopenia. Further studies are needed to assess the role that hypocitraturia may have in this form of bone disease.
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Cameron MA, Sakhaee K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol 2005; 20:1587-92. [PMID: 16133066 DOI: 10.1007/s00467-005-1883-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 01/19/2005] [Accepted: 01/19/2005] [Indexed: 10/25/2022]
Abstract
A metabolic etiology is the most common cause for pediatric kidney stones. Appropriate evaluation of affected children should include assessment of stone type, if available, and assessment of predisposing factors in all cases. This review discusses the metabolic disorders that lead to nephrolithiasis with respect to the development of calcium, uric acid, struvite, and cystine stones. Environmental and hereditary factors are summarized to provide a guide in the evaluation of pediatric stone formers.
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Affiliation(s)
- Mary Ann Cameron
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8885, USA.
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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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Edvardsson V, Elidottir H, Indridason OS, Palsson R. High incidence of kidney stones in Icelandic children. Pediatr Nephrol 2005; 20:940-4. [PMID: 15912382 DOI: 10.1007/s00467-005-1861-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Revised: 01/05/2005] [Accepted: 01/07/2005] [Indexed: 01/29/2023]
Abstract
All children less than 18 years of age who were diagnosed with a first episode of kidney stones at pediatric referral centers in Iceland during the years 1995-2000 were studied retrospectively. The diagnosis was based on clinical features and results of imaging studies. Patients were invited for evaluation at the end of the study period. Twenty-six patients (15 females, 11 males), median age 9.4 (range 0.2-14.9) years, experienced 34 episodes of kidney stones. The annual incidence was 5.6 and 6.3 per 100,000 children less than 18 and 16 years of age, respectively. Abdominal pain was the most common symptom (N=17; 69%) and urinalysis revealed hematuria in 21 patients (80.8%), sterile pyuria in 17 (65%), and 2,8-dihydroxyadeninuria in two. Six patients (23%) had positive urine cultures at the time of diagnosis and five (20%) had urinary tract anomalies. Family history of kidney stones was positive in one third of patients. Metabolic risk factors for stone formation were identified in 22 of 23 patients (96%) who underwent evaluation. Hypercalciuria, the most common metabolic risk factor, was identified in 18 patients (78%). Stones passed spontaneously in nine patients (35%) and six patients had recurrent stone episodes. The incidence of kidney stones in Icelandic children is high compared with other Western populations, affecting females more than males. Underlying metabolic risk factors were identified in most patients.
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Affiliation(s)
- Vidar Edvardsson
- Department of Pediatrics, Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland
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