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Kunchur MG, Mauch TJ, Parkanzky M, Rahilly LJ. A review of renal tubular acidosis. J Vet Emerg Crit Care (San Antonio) 2024. [PMID: 39023331 DOI: 10.1111/vec.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 10/14/2022] [Accepted: 11/11/2022] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA. DATA SOURCES Scientific reviews and original research publications on people and small animals focusing on RTA. SUMMARY RTA is characterized by defective renal acid-base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid-base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion. CONCLUSIONS Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.
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Affiliation(s)
| | - Teri Jo Mauch
- University of Nebraska Medical Center and Children's Hospital, Omaha, Nebraska, USA
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Louisa J Rahilly
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
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Castellani D, Giulioni C, De Stefano V, Brocca C, Fuligni D, Galosi AB, Teoh JYC, Sarica K, Gauhar V. Dietary management of hypocitraturia in children with urolithiasis: results from a systematic review. World J Urol 2023; 41:1243-1250. [PMID: 36645461 DOI: 10.1007/s00345-023-04282-6] [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: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Hypocitraturia is a low urinary excretion of citrate and a well-known risk factor for kidney stone development in children. This systematic review aimed to evaluate the dietary management of hypocitraturia in children with urolithiasis. METHODS Literature search was performed on 30th September 2022 using Embase, PubMed, and Cochrane Central Controlled Register of Trials. Studies were included if children with stones and hypocitraturia were managed with diet supplements. RESULTS Six papers were included. Four studies evaluated the role of oral potassium citrate associated with high fluid intake on stone resolution and recurrence. Two studies assessed the impact of oral potassium citrate on long-term stone recurrence after percutaneous nephrolithotomy and shock wave lithotripsy. All studies demonstrated that the association of potassium citrate and high fluid intake was well tolerated with no side effects and restored normal urine citrate excretion, allowed a reduction in stone size, and, following definitive treatments, was associated with a lower rate of stone regrowth and recurrence compared with controls. These effects were demonstrated across all pediatric ages. CONCLUSIONS Our review infers that oral potassium citrate and high fluid assumption are safe and effective in restoring urine citrate excretion, treating and preventing stone recurrence with no serious adverse events, and should probably be the first-line treatment of pediatric patients with asymptomatic stones and hypocitraturia.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy. .,Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy.
| | - Carlo Giulioni
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy.,Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Malaki M, Seyedzadeh SA. Spot Urinary Citrate Normograms in Children. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:96-99. [PMID: 38092721 DOI: 10.4103/1319-2442.391007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Citrate in the urine inhibits nephrolithiasis, and oral citrate solutions are used to prevent stones forming. The present study aimed to estimate the normograms of the urinary levels of citrate, creatinine, and their ratio in spot urine samples collected from 237 healthy children, aged from 1 month to 14 years. The findings showed the mean, standard deviation, median, and 5th and 95th percentiles of the values and compared them among age groups and between the sexes by using analysis of variance and independent t-tests. Our findings indicate that the ratio of spot urinary citrate to creatinine was higher for children younger than 18 months of age, possibly related to the consumption of dairy protein as their main meal. The 5th percentiles (lower cut off) for spot urinary citrate-to-creatinine ratio, were 915 mg/g for children aged under 18 months, 109 mg/g and 126 mg/g for older boys and girls.
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Horváth O, Szabó AJ, Reusz GS. How to define and assess the clinically significant causes of hematuria in childhood. Pediatr Nephrol 2022:10.1007/s00467-022-05746-4. [PMID: 36260163 PMCID: PMC9580432 DOI: 10.1007/s00467-022-05746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Abstract
Given the wide diversity of causes of hematuria, ranging from simple urinary tract infections with rapid recovery to severe glomerulonephritis with fast decline in kidney function, it is essential to recognize the underlying disease. The first objective of the assessment is to determine whether the cause of the hematuria is medically significant. The combination of hematuria with proteinuria, the presence of hypertension, or worsening kidney function can represent signs of progressive kidney disease. Differentiating the various causes of hematuria is often simple and obvious based on the clinical signs and gross appearance of the urine. However, in some instances, additional non-invasive investigations, such as ultrasound imaging, urinary red cell morphology, measurement of calcium and other solutes in the urine, evaluation of kidney function, and protein excretion, are needed to elucidate the nature of the hematuria. Taking a detailed family history can help in establishing the underlying cause in cases of familial hematuria. On the other hand, the decision to perform a kidney biopsy in children with asymptomatic hematuria remains a challenging issue for clinicians. Ultimately, the frequency of diagnosis of glomerular involvement causing hematuria may depend on the threshold for performing a kidney biopsy. The following review will focus on the diagnostics of hematuria, starting with difficulties regarding its definition, followed by various means to differentiate between urinary, glomerular, and other causes, and finally reviewing the most common diseases that, due to their frequency or their effect on kidney function, present a diagnostic challenge in everyday practice.
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Affiliation(s)
- Orsolya Horváth
- 1st Department of Pediatrics, Semmelweis University, 53-54 Bókay János Street, Budapest, 1083 Hungary
| | - Attila J. Szabó
- 1st Department of Pediatrics, Semmelweis University, 53-54 Bókay János Street, Budapest, 1083 Hungary
| | - George S. Reusz
- 1st Department of Pediatrics, Semmelweis University, 53-54 Bókay János Street, Budapest, 1083 Hungary
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Kanlaya R, Thongboonkerd V. Persistent Escherichia coli infection in renal tubular cells enhances calcium oxalate crystal-cell adhesion by inducing ezrin translocation to apical membranes via Rho/ROCK pathway. Cell Mol Life Sci 2022; 79:381. [PMID: 35751006 PMCID: PMC11072855 DOI: 10.1007/s00018-022-04414-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 01/18/2023]
Abstract
Recent evidence has suggested that recurrent urinary tract infection (UTI) can cause not only infection stones but also metabolic stones (e.g., those containing calcium oxalate monohydrate or COM). However, precise mechanisms underlying UTI-induced metabolic stones remained unknown. In this study, Escherichia coli, the most common bacterium found in recurrent UTI was used to establish the in vitro model for persistent infection of renal epithelial cells. The promoting effects of persistent E. coli infection on kidney stone formation were validated by COM crystal-cell adhesion assay, followed by immunofluorescence study for changes in surface expression of the known COM crystal receptors. Among the five receptors examined, only ezrin had significantly increased level on the surface of persistently infected cells without change in its total level. Such translocation of ezrin to apical membranes was confirmed by Western blotting of apical membrane and cytosolic fractions and confocal microscopic examination. Additionally, persistent infection increased phosphorylation (Thr567) of ezrin. However, all of these changes induced by persistent E. coli infection were significantly inhibited by small-interfering RNA (siRNA) specific for ezrin or a Rho-associated kinase (ROCK)-specific inhibitor (Y-27632). In summary, this study provides a piece of evidence demonstrating that persistent infection by E. coli, one of the non-urease-producing bacteria, may contribute to COM metabolic stone formation by translocation of ezrin to apical membranes, thereby promoting COM crystal-cell adhesion. Such ezrin translocation was mediated via Rho/ROCK signaling pathway. These findings may, at least in part, explain the pathogenic mechanisms underlying recurrent UTI-induced metabolic kidney stone disease.
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Affiliation(s)
- Rattiyaporn Kanlaya
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Carnes K, Howe A, Feustel PJ, Listman JA, White M, Kogan BA. 24-Hour urine collection for first time pediatric stone formers: Is it worth it? J Pediatr Urol 2021; 17:387.e1-387.e7. [PMID: 33762156 DOI: 10.1016/j.jpurol.2020.12.001] [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: 05/09/2020] [Revised: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/OBJECTIVE 24-h urine collections are recommended for motivated first-time stone formers. Given that children have a lifetime potential for recurrences, metabolic work-up has been recommended. 24-hour urine collections can be problematic, especially in children. We sought to study the benefits of 24-h urine collections in children with stones. STUDY DESIGN We performed a single center, retrospective chart review of the most recent pediatric nephrolithiasis patients under age 18 at our center who supplied their first 24-h urine collection. We assessed whether 24-h urine results led to a change in management and if those patients were adherent to the recommendations. RESULTS Seventy pediatric nephrolithiasis patients who had 24-h urine collection were reviewed. Recommendations other than standard dietary and fluid intake changes were made in 8/70 (11%). A low citrate/calcium ratio (327 vs. 525, p < 0.03) and whether the test was ordered by nephrology vs. urology (26% vs. 2%, p < 0.003) were predictive of an additional recommendation. Of the 8 patients who had changes recommended only 1/8 completed a repeat 24-h urine collection, 3/8 never returned for followed up and 2/8 stopped the medicines prior to follow up. There was no difference in early stone recurrence rates, 55% of the studies were incorrectly collected, and total costs are estimated at $9800. DISCUSSION Our study aimed to evaluate the impact and value of 24-h urine collection in first time pediatric stone formers. We found that 24-h urine collections altered management from standard dietary recommendations in only 11% of cases. These collections were fraught with challenges - 55% of our samples appeared to be incorrectly collected, there was at least one abnormality noted in 100% of collections, these tests are expensive, and patients were poorly compliant with recommendations based on test results. Additionally, changes made based on the 24-h urine results seemed to vary depending on who evaluated the test results. Among cases in which changes were made, nephrologists made alterations at a far greater rate than urologists did. We do acknowledge there are several limitations to our study. First, this is a retrospective chart review. Second, for the urology patients, we were only able to review patient records that were available due to a transition from one electronic medical record to another, resulting in a loss of some earlier patient records. We highly doubt that those records we could not review were significantly different than those we did review. Third, this is a single center design and includes the practice patterns of the providers here. We acknowledge that our local practice patterns may or may not be reflective of national practice patterns, however, most clinicians are likely faced with similar interpretation issues and poor rates of compliance and could benefit from guidelines. CONCLUSION 24-h urine collection for first time pediatric stone formers is expensive, difficult to accomplish and infrequently leads to treatment changes. Our data suggest it adds little for most children with stones and may be better reserved for those children with recurrent stone disease.
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Yılmaz N, Yüksel S, Altıntaş F, Koçyiğit A. Nephrolithiasis during the first 6 months of life in exclusively breastfed infants. Pediatr Nephrol 2021; 36:1227-1231. [PMID: 33150500 DOI: 10.1007/s00467-020-04815-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated etiology and prognosis of infantile nephrolithiasis, including whether lithogenic and anti-lithogenic content of breast milk affects its formation. METHODS Thirty infants with nephrolithiasis and 30 healthy infants exclusively breastfed for the first 6 months of life were included in this prospective cohort case-control study. At entry, age, sex, and timing of birth of patients and controls were recorded. All patients were diagnosed and followed up periodically using ultrasonography. All infants received oral vitamin D (400 units/day). Lithogenic (calcium, oxalate, uric acid, phosphate) and anti-lithogenic (citrate, magnesium) components of maternal milk, serum calcium, phosphate, magnesium, 25-hydroxy vitamin D and parathormone, as well as spot urine calcium, uric acid, cystine, oxalate, magnesium, citrate/creatinine ratio, and calcium/citrate ratio were compared. RESULTS Mean follow-up period was 56.1 ± 6.8 months. There was no difference concerning lithogenic and anti-lithogenic content of breast milk. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels (49.1 ± 19 vs. 26.7 ± 4 ng/ml, p < 0.001) were significantly higher and parathormone level significantly lower in patients. Random urine calcium/creatinine and calcium/citrate ratios were significantly higher in patient group (0.63 ± 0.40 vs. 0.42 ± 0.10 and 0.62 ± 0.12 vs. 0.41 ± 0.25 mg/mg, respectively, p < 0.01). Three patients were lost to follow-up after the first year. At last follow-up, calculi disappeared in 25/27 remaining patients without interventions or therapy. CONCLUSIONS Breast milk does not have an etiologic effect in infantile nephrolithiasis. Higher serum vitamin D levels may have roles in development of lower levels of PTH and higher levels of serum and urine calcium, leading to stone formation. The prognosis for infantile stones is excellent. Graphical abstract.
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Affiliation(s)
- Neslihan Yılmaz
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Mavi Bina 1 Kat, Kinikli, 20070, Denizli, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Mavi Bina 1 Kat, Kinikli, 20070, Denizli, Turkey.
| | - Fatih Altıntaş
- Department of Physiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ali Koçyiğit
- Department of Radiology, Istinye University, Liv Hospital, Istanbul, Turkey
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Ubetagoyena Arrieta M, Areses Trapote R, Mendia Ubetagoyena J, Pérez Revuelta M, Letona Luqui M. Renal lithiasis in pediatric patients: correlation of methods that depend on 24-hour collections with simpler methods that do not require timed urine. Actas Urol Esp 2021; 45:146-153. [PMID: 33160758 DOI: 10.1016/j.acuro.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/13/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Daily practice requires quick, simple and accessible methods to appropriately assess the urinary excretion of solutes in diagnostic or follow-up evaluations of children with renal lithiasis. OBJECTIVES The objective of this study was to correlate urine elimination of substances related to renal lithiasis that depend on the volume of excreted urine in a unit of time with other parameters that are calculated by measuring the concentration of these substances in blood and urine, such as urinary ratios, fractional excretions and excretion rates. MATERIALS AND METHODS The study included 401 healthy children aged 3-14 years (187 boys and 214 girls), mean age 8.78±3.40 years. The analysis was carried out by Pearson's correlation coefficient. RESULTS There was significant correlation between the elimination of sodium, potassium and chlorine in 24-hour urine sample and the urinary ratios and fractional excretions of these ions. Urinary ratios and rates of excretion of calcium, uric acid, phosphate, magnesium, citrate and oxalate were highly correlated with the determinations of these substances in 24-hour collections. CONCLUSIONS These equations provide relevant information for the study of the etiology of renal lithiasis in children, as well as about compliance to dietary treatment. They also assess the effectiveness of the various treatments used in these patients, without having to resort to 24-hour collections, which pose a considerable challenge in the pediatric age group.
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Abstract
BACKGROUND Outcomes of pediatric intestinal failure (PIF) have improved recently, with other comorbidities, such as increased echogenicity/nephrocalcinosis on ultrasound (US) in long-term survivors now evident. We evaluated the significance of nephrocalcinosis over time in PIF and its impact on renal function. METHODS Retrospective analysis on a cohort of PIF patients was performed. Presence of nephrocalcinosis and/or increased renal echogenicity (identified on US), estimated glomerular filtration rate (eGFR; ml · min · 1.73 m2), renal tubular function, PN volume (ml · kg · day) and PN exposure time (hours/day) were reviewed annually over a follow-up period of 2 years. Outcomes in the nephrocalcinosis versus normal US groups were compared. RESULTS Forty patients (28 boys, median age 2.7 years) were followed for 2 years. Fifteen (38%) had either increased echogenicity or nephrocalcinosis (group 1) at initial US. US were normal in the remaining 25 (62%) on initial assessment (group 2). eGFR did not differ between group 1 and group 2 at baseline (118 vs 133, P = 0.51) and year 2 (130 vs 131, P = 1.00). The percentage of patients with abnormal markers of tubular function was similar in both groups at year 2 (high urine calcium: creatinine 33 versus 30, P = 0.83; high urine calcium: citrate 39 versus 42, P = 0.87; low urine citrate: creatinine 15 versus 17, P = 1.00; high urine oxalate: creatinine 39 versus 25, P = 0.77). CONCLUSIONS A large proportion of PIF patients with a history of parenteral nutrition (PN) exposure have nephrocalcinosis and/or increased echogenicity on US. Over a 2-year follow-up period, however, these abnormalities had no impact on eGFR or renal tubular function.
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Mir C, Rodriguez A, Rodrigo D, Saez-Torres C, Frontera G, Lumbreras J, Espinosa N, Gomez C, Costa-Bauza A, Grases F. Analysis of urine composition from split 24-h samples: use of 12-h overnight samples to evaluate risk factors for calcium stones in healthy and stone-forming children. J Pediatr Urol 2020; 16:371.e1-371.e7. [PMID: 32276885 DOI: 10.1016/j.jpurol.2020.02.011] [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: 10/18/2019] [Accepted: 02/16/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The analysis of 24-h urine is the gold standard to diagnose metabolic abnormalities in the stone-forming patient. However, urinary composition changes throughout the day and analyzing the whole 24-h urine may mask peaks of increased risk of crystallization. OBJECTIVE To examine variations of stone-promoting and stone-inhibiting factors in urine using split 24-h samples from healthy and stone-forming children. STUDY DESIGN Urine was collected from 87 healthy and 26 stone-forming children using a split collection procedure (12-h daytime urine and 12-h overnight urine). Urine volume, pH, calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) were determined, and the Ca/Cit ratio was calculated. RESULTS The overnight urine samples in both groups had higher levels of P and Mg, lower volume, lower pH, and less citrate and uric acid. As can be seen in the table, higher percentages of healthy and stone-forming children had altered 12-h night urine than 24-h urine with regards to Ca/Cr, Cit/Cr and Ca/Cit ratios. All healthy subjects and all stone-forming children (except one) with altered Cit/Cr ratios or Ca/Cit ratios in the 24-h sample also had altered ratios in the 12-h overnight sample. DISCUSSION This study indicates that urine composition changes throughout the day, and that there is daily variability in most of the parameters related to kidney stone formation. Furthermore, 12-h overnight samples seem to be more sensitive than 24-h samples in detecting the most common urinary abnormalities. The main limitation of this study is the relative low sample size of stone-forming children, owing to the low prevalence of nephrolithiasis in childhood. CONCLUSIONS We observed a higher excretion of stone-promoting substances and a lower citrate in urine at night. However, the study results do not provide enough evidence to conclude that the use of a 12-h overnight sample collection can replace 24 h urine analysis in the metabolic evaluation of children with lithiasis.
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Affiliation(s)
- Concepcion Mir
- Multidisciplinary Paediatrics Research Group (IdISBa), Son Espases University Hospital, 07020, Palma de Mallorca, Spain; Department of Paediatric Nephrology, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain.
| | - Dolores Rodrigo
- Multidisciplinary Paediatrics Research Group (IdISBa), Son Espases University Hospital, 07020, Palma de Mallorca, Spain; Department of Paediatric Nephrology, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Javier Lumbreras
- Multidisciplinary Paediatrics Research Group (IdISBa), Son Espases University Hospital, 07020, Palma de Mallorca, Spain; Department of Paediatric Nephrology, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Natalia Espinosa
- Department of Paediatric Nephrology, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Cristina Gomez
- Laboratory Department, Son Espases University Hospital, 07020, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
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Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vieira MS, Francisco PDC, Hallal ALLC, Penido MGMG, Bresolin NL. Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis. J Pediatr (Rio J) 2020; 96:333-340. [PMID: 30731051 PMCID: PMC9432078 DOI: 10.1016/j.jped.2018.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. METHODS Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. RESULTS 40 individuals were analyzed. Mean age at diagnosis was 7.2±4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. CONCLUSION Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications.
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Affiliation(s)
- Mariana S Vieira
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Pediatria, Florianópolis, SC, Brazil
| | - Priscila de C Francisco
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Pediatria, Florianópolis, SC, Brazil; Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Ana Luiza L C Hallal
- Universidade de São Paulo (USP), São Paulo, SP, Brazil; Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Saúde Pública, Florianópolis, SC, Brazil
| | - Maria Goretti M G Penido
- University of Missouri, School of Medicine, The Childrens Mercy Hospitals and Clinics, Bone and Mineral Disorders Clinic and Research Laboratory, Section of Pediatric Nephrology, Kansas, United States; Santa Casa de Belo Horizonte, Serviço de Nefrologia, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Nilzete L Bresolin
- Universidade Federal de Santa Catarina (UFSC), Centro de Ciências da Saúde, Departamento de Pediatria, Florianópolis, SC, Brazil; Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Hospital Infantil Joana de Gusmão, Unidades de Nefrologia Pediátrica e de Terapia Intensiva, Florianópolis, SC, Brazil Received 31 August 2018; accepted 31 October 2018.
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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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Srivastava A, Swain KK, Chahar V, Bhardwaj S, Ajith N, Mete U, Garg U, Srivastava T. Role of diet and trace elements in lithogenesis of renal calculi. J Radioanal Nucl Chem 2019. [DOI: 10.1007/s10967-018-6335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Gafni RI, Langman CB, Guthrie LC, Brillante BA, James R, Yovetich NA, Boyce AM, Collins MT. Hypocitraturia Is an Untoward Side Effect of Synthetic Human Parathyroid Hormone (hPTH) 1-34 Therapy in Hypoparathyroidism That May Increase Renal Morbidity. J Bone Miner Res 2018; 33:1741-1747. [PMID: 29878514 DOI: 10.1002/jbmr.3480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 11/06/2022]
Abstract
Subcutaneous human parathyroid hormone (hPTH) therapy can effectively manage hypocalcemia in hypoparathyroidism, with varying effects on hypercalciuria. However, little is known about its ability to decrease the renal comorbidities of hypoparathyroidism: nephrocalcinosis (NC), nephrolithiasis (NL), and renal insufficiency. Urinary citrate (Ucit) promotes the solubility of urinary calcium (UCa); hypocitraturia is a risk factor for NC/NL. Twenty-four-hour UCa, Ucit, and UCa/Ucit were determined in 31 hypoparathyroid subjects receiving hPTH 1-34 therapy for up to 5 years. Before hPTH 1-34, the geometric least squares mean UCa was 346 mg/day (normal <250) and Ucit was 500 mg/day (normal 250-1190); UCa/Ucit was 0.67 mg/mg. After 6 months of hPTH 1-34, UCa decreased (238, p < 0.001), but with a greater decrease in Ucit (268, p < 0.001), increasing UCa/Ucit, which became significant over time (p < 0.001). After stopping hPTH 1-34 and resuming conventional therapy (follow-up; FU), compared to the last measures on hPTH 1-34, Ucit rose to 626 (p < 0.001), reducing UCa/Ucit to 0.44, (p < 0.05); UCa also rose (273), but was still lower than baseline (p < 0.05). Daily hPTH 1-34 dose did not correlate with UCa, but was inversely related to Ucit, and directly related to UCa/Ucit (p < 0.01). Mean blood bicarbonate decreased significantly on hPTH 1-34 and remained lower than baseline at FU (p < 0.01). Mean eGFR increased on hPTH 1-34 (86 to 96 mL/min/1.73 m2 , p < 0.001) and returned to baseline at FU. On renal imaging, 6 subjects did not have NC/NL, 8 had NC/NL prior to hPTH 1-34 that remained unchanged, and 16 developed new-onset (n = 10) or progressive (n = 6) NC/NL while on hPTH 1-34. Our data demonstrate that treatment with subcutaneous hPTH 1-34 may have an untoward effect of hypocitraturia and high UCa/Ucit ratio that may increase renal morbidity. With increasing use of PTH therapy in hypoparathyroidism, close monitoring and exploration for treatment of hypocitraturia seem warranted. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Rachel I Gafni
- Skeletal Distorders and Mineral Homeostasis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University and the Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lori C Guthrie
- Skeletal Distorders and Mineral Homeostasis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Beth A Brillante
- Skeletal Distorders and Mineral Homeostasis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Alison M Boyce
- Skeletal Distorders and Mineral Homeostasis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael T Collins
- Skeletal Distorders and Mineral Homeostasis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
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Chan KH, Moser EA, Whittam BM, Misseri R, Cain MP, Krambeck A. The ability of a limited metabolic assessment to identify pediatric stone formers with metabolic abnormalities. J Pediatr Urol 2018; 14:331.e1-331.e6. [PMID: 30177386 DOI: 10.1016/j.jpurol.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION American Urological Association guidelines recommend a urinary metabolic evaluation after the first stone event in all pediatric stone patients. Prior studies identified hypercalciuria and urine hypovolemia as the most common abnormalities in children with urolithiasis. Recent data suggest that hypocitraturia is most prevalent. It was hypothesized that a limited evaluation would detect the majority of clinically significant metabolic abnormalities in pediatric stone formers. MATERIAL AND METHODS A retrospective analysis of all children (<18 years of age) with renal/ureteral calculi evaluated at the study institution from 2005 to 2015 was performed. Children with ≥ one 24-h urinary metabolic profile after a clinical visit for renal/ureteral calculi were included. Those with bladder stones and those with undercollection or overcollection or missing urinary creatinine were excluded. Demographics and data from the first urinary metabolic profile and stone analyses were collected. The sensitivity, specificity, and positive and negative predictive value (NPV) of a limited urinary metabolic evaluation consisting of four parameters (24-h calcium, citrate, and oxalate and low urinary volume) were compared to a complete urinary metabolic profile. The number and type of metabolic abnormalities that would have been missed with this limited evaluation weredetermined. RESULTS Of 410 patients, 21 were excluded for age ≥18 years, 13 for bladder stones, 248 for overcollections, 38 for undercollections, and 10 for missing creatinine. This left 80 patients for inclusion: median age 11.4 years, 60% female, and 96.3% white. Of the entire cohort, 69.6% had hypocitraturia, 52.5% had low urine volume, and 22.5% had hypercalciuria. Sensitivity was 87.5%. Specificity could not be calculated because no patients had a normal complete metabolic evaluation. The NPV was zero, and the positive predictive value was 100%, but these are artifacts resulting from the absence of patients with a normal complete metabolic evaluation. Of the 80 patients, 10 had at least one abnormality missed by a limited metabolic evaluation (Table 1). The missed abnormalities were high pH (n = 6), abnormal 24-h phosphorus (low in 1 patient and high in 1 patient), low 24-h magnesium (n = 3), low 24-h potassium (n = 3), and high 24-h sodium (n = 4). DISCUSSION A limited urinary metabolic evaluation would have detected the vast majority of clinically significant metabolic abnormalities in the study sample. Approximately two-thirds of the study patients submitted inadequate 24-h urine specimens. CONCLUSIONS A simplified approach to metabolic evaluation in first-time stone formers with a stone analysis available was proposed. This streamlined approach could simplify the metabolic evaluation and reduce health care costs.
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Affiliation(s)
- K H Chan
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA; Center for Pediatric and Adolescent Comparative Effectiveness Research and Department of Biostatistics, 410 W. 10th St. Suite 2000, Indianapolis, IN 46202, USA.
| | - E A Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - B M Whittam
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - R Misseri
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - M P Cain
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - A Krambeck
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
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García Nieto VM, Pérez Bastida XI, Salvador Cañibano M, García Rodríguez VE, Monge Zamorano M, Luis Yanes MI. Cuantificación del riesgo de formación de cálculos cálcicos en la orina correspondiente a 2 momentos del día en un grupo de niños estudiados para descartar prelitiasis. Nefrologia 2018; 38:267-272. [DOI: 10.1016/j.nefro.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/12/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022] Open
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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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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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Calcium-to-Citrate Ratio Distinguishes Solitary and Recurrent Urinary Stone Forming Children. J Urol 2017; 198:416-421. [DOI: 10.1016/j.juro.2017.03.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/22/2022]
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Calcium oxalate urolithiasis in children: urinary promoters/inhibitors and role of their ratios. Eur J Pediatr 2016; 175:1959-1965. [PMID: 27730307 DOI: 10.1007/s00431-016-2792-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/17/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
UNLABELLED Diagnostic criteria for determination of inclination towards idiopathic calcium oxalate (CaOx) urolithiasis based on biochemical urine parameters are not sufficiently well defined in children. The aim of this study was to determine the risk of CaOx urolithiasis in children from concentrations of calcium, oxalate, citrate, and glycosaminoglycans in urine and their ratios, all standardized in respect to creatinine. We collected and analyzed 24-h urine samples of children with CaOx urolithiasis (n = 61) and compared with urine samples of matched control group of healthy children (n = 25). The study has showed that all stone formers have higher excretion of calcium (mmol/mmol creatinine), calcium/citrate (mol/mmol), and oxalate/(citrate × glycosaminoglycans) ratio (mol Ox × mol cr)/(mol Cit × g GAGs). ROC analysis of these variables gave criteria (>0.28, >1.07, and >0.08, respectively) for distinguishing stone formers from healthy children. Biochemical urine parameters and their ratios (calcium, calcium citrate, and oxalate/(citrate × glycosaminoglycans) enable one to discriminate idiopathic calcium oxalate stone formers from healthy children. Oxalate/(citrate × glycosaminoglycans) ratio per se can serve as an independent risk for stone formation. CONCLUSION Using biochemical urine parameters and their ratios such as calcium, calcium/citrate, and oxalate/(citrate × glycosaminoglycans) enables one to determine diagnostic criteria towards idiopathic calcium oxalate urolithiasis in children. What is known: • The role of urine calcium as a promoter in calcium oxalate urolithiasis is well established. • Seldom used calcium/citrate ratio is acknowledged as a risk factor for calcium/oxalate urolithiasis. What is new: • The values of calcium and citrate in clinically and genetically proven idiopathic calcium oxalate urolithiasis make calcium/citrate ratio useful for diagnostic purposes in such stone formers. • Rarely used calcium independent oxalate/(citrate x glycosaminoglycans) ratio serves as the second best high specificity marker for idiopathic calcium oxalate urolithiasis.
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Qamar J, Khan MAM, Nazir Z. Protean and intangible manifestation of renal stones in children. Int J Surg 2016; 36:647-648. [PMID: 27847294 DOI: 10.1016/j.ijsu.2016.11.022] [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: 11/05/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Abstract
In the last decade, renal stones are being diagnosed more frequently in children across the globe. Children with renal stone often present with non-specific and subtle symptoms. Diagnosis of urolithiasis in children therefore requires a high index of suspicion especially for those living in endemic regions and with a positive family history. Additionally, management requires judicious use of radiological imaging by treating physicians.
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Affiliation(s)
- Javaria Qamar
- Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, Karachi, 74800, Pakistan
| | - Muhammad Arif Mateen Khan
- Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, Karachi, 74800, Pakistan
| | - Zafar Nazir
- Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, Karachi, 74800, Pakistan.
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Kosar C, De Silva N, Avitzur Y, Steinberg K, Courtney-Martin G, Chambers K, Fitzgerald K, Harvey E, Wales PW. Prevalence of renal abnormality in pediatric intestinal failure. J Pediatr Surg 2016; 51:794-7. [PMID: 26921935 DOI: 10.1016/j.jpedsurg.2016.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Outcomes of children with intestinal failure have improved over the last decade. However, with improved survival, other co-morbidities have become evident. The goal of our study was to evaluate the presence of renal nephrocalcinosis or increased echogenicity in a cohort of patients with pediatric intestinal failure (PIF). METHODS A cross-sectional prevalence design was performed in PIF patients followed by our intestinal rehabilitation program between 2013 and 2014. Renal function was evaluated using serum creatinine and urea, urine oxalate, creatinine, calcium, and calcium/creatinine ratios. Renal ultrasounds were performed to assess for echogenicity. Data was collected on intestinal failure related factors and nutritional intake. Data was analyzed using medians and Mann-Whitney U or proportions and chi square. RESULTS Fifty-four patients (median age 48months; 33 males (61%) were studied. Twenty-two patients (41%) had increased echogenicity or nephrocalcinosis on ultrasound. There were no differences in serum Creatinine or urea, but patients with nephrocalcinosis had statistically different calcium:creatinine ratio (1.69 vs 0.74; p=0.043), urine oxalate (108 vs 219; p=0.06), and serum phosphate (1.55 vs 1.75; p=0.044). Patients with echogenicity had a shorter colonic remnant (25cm vs 31cm; p=0.01), a history of longer PN exposure (928 vs 483days; p=0.05), percent PN calories (37 vs 0; p=0.05), PN h/day (13 vs 0; p=0.05), but no difference in PN Ca/phosphate/magnesium content (mmol/kg). CONCLUSION A large proportion of PIF patients have increased echogenicity/nephrocalcinosis on ultrasound that is associated with prolonged PN exposure. This has implications for long-term management. Regular surveillance is required, and further study is warranted to determine specific risk factors.
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Affiliation(s)
- Christina Kosar
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Nicole De Silva
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Yaron Avitzur
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Canada
| | - Karen Steinberg
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Glenda Courtney-Martin
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Kathryn Chambers
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Kevin Fitzgerald
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada
| | - Elizabeth Harvey
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada; Division of Nephrology, The Hospital for Sick Children, University of Toronto, Canada
| | - Paul W Wales
- Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, University of Toronto, Canada; Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Canada.
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Lee H, Shim SY, Park EA, Cho SJ. The Clinical Features and Prognosis of Nephrocalcinosis in Preterm Neonates : A Single Center Study in Korea. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - So Yeon Shim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Barr-Beare E, Saxena V, Hilt EE, Thomas-White K, Schober M, Li B, Becknell B, Hains DS, Wolfe AJ, Schwaderer AL. The Interaction between Enterobacteriaceae and Calcium Oxalate Deposits. PLoS One 2015; 10:e0139575. [PMID: 26448465 PMCID: PMC4598009 DOI: 10.1371/journal.pone.0139575] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
Background The role of calcium oxalate crystals and deposits in UTI pathogenesis has not been established. The objectives of this study were to identify bacteria present in pediatric urolithiasis and, using in vitro and in vivo models, to determine the relevance of calcium oxalate deposits during experimental pyelonephritis. Methods Pediatric kidney stones and urine were collected and both cultured and sequenced for bacteria. Bacterial adhesion to calcium oxalate was compared. Murine kidney calcium oxalate deposits were induced by intraperitoneal glyoxalate injection and kidneys were transurethrally inoculated with uropathogenic Escherichia coli to induce pyelonephritis Results E. coli of the family Enterobacteriaceae was identified in patients by calcium oxalate stone culture. Additionally Enterobacteriaceae DNA was sequenced from multiple calcium oxalate kidney stones. E. coli selectively aggregated on and around calcium oxalate monohydrate crystals. Mice inoculated with glyoxalate and uropathogenic E. coli had higher bacterial burdens, increased kidney calcium oxalate deposits and an increased kidney innate immune response compared to mice with only calcium oxalate deposits or only pyelonephritis. Conclusions In a murine model, the presence of calcium oxalate deposits increases pyelonephritis risk, likely due to preferential aggregation of bacteria on and around calcium oxalate crystals. When both calcium oxalate deposits and uropathogenic bacteria were present, calcium oxalate deposit number increased along with renal gene transcription of inner stone core matrix proteins increased. Therefore renal calcium oxalate deposits may be a modifiable risk factor for infections of the kidney and urinary tract. Furthermore, bacteria may be present in calcium oxalate deposits and potentially contribute to calcium oxalate renal disease.
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Affiliation(s)
- Evan Barr-Beare
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Vijay Saxena
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Evann E. Hilt
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Krystal Thomas-White
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Megan Schober
- Nationwide Children’s Hospital, Division of Urology, Columbus, Ohio, United States of America
| | - Birong Li
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Brian Becknell
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
| | - David S. Hains
- Lebonheur Children’s Hospital, Division of Nephrology, Memphis, Tennessee, United States of America
| | - Alan J. Wolfe
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Andrew L. Schwaderer
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
- * E-mail:
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Penido MGMG, Tavares MDS. Pediatric primary urolithiasis: Symptoms, medical management and prevention strategies. World J Nephrol 2015; 4:444-454. [PMID: 26380196 PMCID: PMC4561842 DOI: 10.5527/wjn.v4.i4.444] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
In the past few decades pediatric urolithiasis has become more frequent. The reason for this increase is not completely clear but has been attributed to changes in climate, nutritional habits and possibly other environmental factors. Although less frequent than adult stone disease, urolithiasis in the pediatric age group is also related to significant morbidity, particularly since stones tend to recur, and, thus, should not be underestimated. Most children with idiopathic stone disease have an underlying metabolic abnormality substantiating the importance of metabolic evaluation already following initial diagnosis of urolithiasis. Identification of the metabolic abnormality allows for more specific prescription of non pharmacological and pharmacological interventions aimed at preventing recurrent stone formation. A better understanding of the causes of kidney stone disease will provide better strategies for stone prevention in children.
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Does obesity or hyperuricemia influence lithogenic risk profile in children with urolithiasis? Pediatr Nephrol 2015; 30:797-803. [PMID: 25380789 PMCID: PMC4372672 DOI: 10.1007/s00467-014-2999-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/09/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are indications that obesity and hyperuricemia may influence the formation and composition of urinary stones. The aim of our study was to determine the effect of obesity and hyperuricemia on the urinary lithogenic risk profile in a large cohort of pediatric patients. METHODS The study population comprised 478 children with urolithiasis and 517 healthy children (reference group). We studied the effects of obesity on the lithogenic profile by dividing the patients with urolithiasis into two groups based on body mass index Z-score (patients who were overweight/obese vs. those with normal weight for age) and comparing the two groups. To study the effect of hyperuricemia on the lithogenic profile, we divided the patients with urolithiasis into two groups based on the presence or not of hyperuricemia (110 patients with urolithiasis accompanied by hyperuricemia vs. 368 patients with urolithiasis and normal serum uric acid levels) and compared the groups. RESULTS Among the children and adolescents with urolithiasis and hyperuricemia, there was a significantly lower excretion of crystallization inhibitors (citrates, magnesium). We also found significantly negative correlations between serum uric acid levels and the urine citrate/creatinine ratio (citrate/cr.; r = -0.30, p < 0.01), as well as the magnesium/cr. ratio (Mg/cr.; r = -0.33, p < 0.01). There was no statistically significant differences in the urinary excretion of oxalates, citrates, calcium, phosphorus, magnesium and uric acid between children with urolithiasis who were either overweight or obese and children with urolithiasis who had a normal body weight. CONCLUSIONS In our pediatric patient cohort, hyperuricemia was associated with a decrease in the excretion of crystallization inhibitors in the urine, but the clinical relevance of this observation needs to be confirmed in future studies. Obesity and overweight had no direct influence on the lithogenic risk profile in the urinary stone formers in our study, but there was an indication that higher serum uric acid may be associated with impairment in renal function, which in turn could influence the excretion of lithogenic parameters.
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Jackson E. Between a rock and a hard place: getting families to change behaviors to reduce pediatric stone disease recurrence. J Urol 2014; 192:1324-5. [PMID: 25130524 DOI: 10.1016/j.juro.2014.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Elizabeth Jackson
- Pediatric Urology and Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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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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Penido MGMG, Tavares MDS, Guimarães MMM, Srivastava T, Alon US. American and Brazilian Children With Primary Urolithiasis: Similarities and Disparities. Glob Pediatr Health 2014; 1:2333794X14561289. [PMID: 27335922 PMCID: PMC4804672 DOI: 10.1177/2333794x14561289] [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] [Indexed: 12/16/2022] Open
Abstract
Objectives. Considering the differences in location, socioeconomic background, and cultural background, the aim of this study was to try to identify possible factors associated with the increased incidence of urolithiasis by comparing American and Brazilian children with stones. Methods. Data of 222 American and 190 Brazilian children with urolithiasis were reviewed including age, gender, body mass index, imaging technique used (ultrasound and computed tomography), and 24-hour urine volume and chemistries. Results. There were no differences between age and gender at diagnosis. Brazilian children were leaner but in no population did obesity rate exceed that of the general population. Ultrasound was most commonly used to diagnose stones, even more so in Brazilians. Decreased urine flow was more common among Americans (P = .004), hypercalciuria among Brazilians (P = .001), and elevated Ca/citrate ratio among Americans (P = .009). There were no differences between the groups in the frequency of hypocitraturia, hyperuricosuria, absorptive hyperoxaluria, and cystinuria. Conclusions. Despite some differences between the populations, the leading causes of urolithiasis among both were “oliguria,” hypercalciuria, and high Ca/citrate ratio. In neither country was obesity the reason for the increase in incidence of urolithiasis, nor was the use of computed tomography. The similarities between the 2 populations call for combining efforts in addressing the leading causes of pediatric urolithiasis.
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Kirejczyk JK, Porowski T, Konstantynowicz J, Kozerska A, Nazarkiewicz A, Hoppe B, Wasilewska A. Urinary citrate excretion in healthy children depends on age and gender. Pediatr Nephrol 2014; 29:1575-82. [PMID: 24696006 PMCID: PMC4147207 DOI: 10.1007/s00467-014-2806-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypocitraturia is considered a major risk factor for calcium stone formation. However, there is no widely accepted reference database of urinary citrate excretion in children. The aim of our study was to determine the amount of citrate eliminated in the urine over a 24-h period in a pediatric cohort and to determine an optimal unit reflecting excretion. METHODS The study cohort comprised 2,334 healthy boys and girls aged 2-18 years. The levels of urinary citrate were assessed by an enzymatic method in 24-hour urine and expressed in absolute values, as urinary concentration, citrate/creatinine ratio, per kilogram of body weight, in relation to 1.73 m2, and as the calcium/citrate index. RESULTS Similar incremental age-related citraturia rates were observed in both male and female subjects until puberty during which time citrate excretion became significantly higher in girls. Urinary citrate adjusted for creatinine and for body weight showed a significantly decreasing trend with increasing age in both sexes. Urinary citrate corrected for body surface was weakly correlated with age. Thus, the assumption of 180 mg/1.73 m2/24 h for males and 250 mg/1.73 m2/24 h for females as lower cut-off values appeared to be reliable from a practical perspective. CONCLUSIONS We found distinct sex-dependent differences in citraturia at the start of puberty, with significantly higher values of urinary citrate in girls than in boys. Further prospective studies are warranted to elucidate whether this difference represents a differentiated risk of urolithiasis.
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Affiliation(s)
- Jan K. Kirejczyk
- Department of Pediatric Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Tadeusz Porowski
- Department of Pediatric Nephrology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics and Developmental Disorders, Medical University of Bialystok, Bialystok, Poland
| | - Agata Kozerska
- Department of Pediatric Nephrology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
| | | | - Bernd Hoppe
- Department of Pediatrics, Division of Pediatric Nephrology, University of Bonn, Bonn, Germany
| | - Anna Wasilewska
- Department of Pediatric Nephrology, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Bialystok, Poland
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Akın Y, Uçar M, Yücel S. Current medical treatment in pediatric urolithiasis. Turk J Urol 2013; 39:253-63. [PMID: 26328120 DOI: 10.5152/tud.2013.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/30/2013] [Indexed: 11/22/2022]
Abstract
Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range from 6.5-54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kidney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recurrence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of the urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.
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Affiliation(s)
- Yiğit Akın
- Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Murat Uçar
- Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Selçuk Yücel
- Department of Urology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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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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Correspondence between Ca²⁺ and calciuria, citrate level and pH of urine in pediatric urolithiasis. Pediatr Nephrol 2013; 28:1079-84. [PMID: 23377289 PMCID: PMC3661906 DOI: 10.1007/s00467-013-2420-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/21/2012] [Accepted: 01/07/2013] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hypercalciuria and hypocitraturia are considered the most important risk factors for urolithiasis. Citrate binds to urinary calcium to form a soluble complex which decreases the availability of ionized calcium (Ca(2+)) necessary for calcium oxalate formation and phosphate crystallization. The aims of this study were to assess the Ca(2+) fraction in relation to total calciuria, citraturia and urinary pH and to determine whether urinary Ca(2+) concentration is a helpful biomarker in metabolic evaluation of children with urolithiasis. METHODS We collected 24-h urine samples from 123 stone-forming children and adolescents with hypocitraturia and from 424 healthy controls. Total calciuria (total calcium, Catotal), Ca(2+), pH, citrate, oxalate and Bonn Risk Index (BRI) were assessed and compared between the two groups. RESULTS Total calciuria and Ca(2+) content were higher in stone-formers than in the healthy children. In both stone-formers and controls, Ca(2+) content was inversely related to citraturia and urinary pH, whereas the Ca(2+)/Catotal ratio differed slightly between the groups. A large variability in Ca(2+) level was found across individuals in both groups. The BRI increased with increasing calciuria and urine acidity. CONCLUSIONS Compared to controls, stone-formers with hypocitraturia demonstrated a higher urinary Ca(2+) concentration, but this was proportional to calciuria. The large individual variability in urinary Ca(2+) content limits its practical use in metabolic evaluation of children with urolithiasis. However, the Ca/Citrate ratio may be a useful clinical tool in evaluating children with urolithiasis.
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Penido MGMG, Srivastava T, Alon US. Pediatric primary urolithiasis: 12-year experience at a Midwestern Children's Hospital. J Urol 2012. [PMID: 23201378 DOI: 10.1016/j.juro.2012.11.107] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Due to environmental and social changes (and possibly obesity) as new risk factors for stone formation in adults and changes in imaging techniques, we assessed whether etiologies of primary pediatric urolithiasis have changed, and if relationships exist between the condition and obesity or imaging technique. MATERIALS AND METHODS All pediatric patients with documented primary urolithiasis who underwent serum and 24-hour urine analyses between 1999 and 2010 were evaluated. Age at diagnosis, gender, body mass index and imaging technique were recorded. RESULTS Of the 222 patients (48% male) all had normal serum creatinine, electrolytes and minerals. Primary pediatric urolithiasis was diagnosed by ultrasound in 73% of cases and computerized tomography in 27%. Mean ± SD annual incidence of urolithiasis per 1,000 clinic visits increased from 2.4 ± 1.5 in the first half of the study period to 6.2 ± 2.1 in the second half (p <0.005). Mean ± SD age at diagnosis was 11.8 ± 3.8 years and body mass index was 21.7 ± 5.7 (rate of overweight 15%). A total of 140 patients had urine output less than 1.0 ml/kg per hour, with this being the only abnormality in 54. Hypercalciuria was observed in 46% of patients, hypocitraturia in 10% and high calcium-to-citrate ratio in 51%. Mild absorptive hyperoxaluria was noted in 3 patients and hyperuricosuria in 11, with all 14 exhibiting at least 1 additional abnormality. Cystinuria was present in 1 patient. No etiology was identified in 20 patients (9.0%). CONCLUSIONS Oliguria and hypercalciuria continue to be the most common etiologies of pediatric primary urolithiasis, followed by hypocitraturia. The recent increase in stone incidence is unlikely due to increased use of computerized tomography. Incidence of obesity was not higher than in the general population. Hyperoxaluria and cystinuria are rare, and thus might not be indicated in the initial analysis.
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Affiliation(s)
- Maria Goretti M G Penido
- Pediatric Nephrology Unit, Clinics Hospital, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Clinical presentation and metabolic features of overt and occult urolithiasis. Pediatr Nephrol 2012; 27:101-7. [PMID: 21688190 DOI: 10.1007/s00467-011-1940-8] [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: 03/30/2011] [Revised: 05/27/2011] [Accepted: 05/27/2011] [Indexed: 12/14/2022]
Abstract
Although pediatricians are frequently confronted with patients presenting urolithiasis symptoms without obvious stones, the syndrome of occult urolithiasis may be still viewed with some skepticism. We have compared the clinical and metabolic features of 197 children with obvious calculi, 189 with microcalculi (diameter ≤ 3 mm based on renal sonography), and 114 with symptoms of urolithiasis and normal renal sonography findings. Only microcalculi and normal sonography subjects with a urinary abnormality potentially leading to urolithiasis were included in the study. Age at presentation increased significantly (p = 0.0001) in the groups in the order normal sonography to microcalculi to calculi groups. There was no significant difference among the three groups in terms of family history of urolithiasis, gender distribution, and degree of hypercalciuria, hyperuricosuria, hyperoxaluria, or hypocitraturia. The average frequency of pain attacks of patients with recurrent abdominal pain (RAP) ranged from 3.6 to 4.6 days of pain per month among the three groups, which is four to ninefold lower than that reported for children with functional or organic gastrointestinal RAP. The consistency of many clinical and urinary metabolic characteristics indicates a common underlying disorder in overt and occult urolithiasis. The increase of age at presentation from the normal sonography to microcalculi and calculi groups may reflect progressive crystal accretion leading ultimately to overt stone formation.
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Giapros V, Tsoni C, Challa A, Cholevas V, Argyropoulou M, Papadopoulou F, Siomou E, Drougia A, Andronikou S. Renal function and kidney length in preterm infants with nephrocalcinosis: a longitudinal study. Pediatr Nephrol 2011; 26:1873-80. [PMID: 21533868 DOI: 10.1007/s00467-011-1895-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 03/31/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
Renal injury in early life may lead to hypertension and renal disease in adulthood. In this prospective study, we estimated renal glomerular and tubular function and kidney length (KL) during the first 2 years of life of preterm infants with nephrocalcinosis (NC) associated with prematurity. The study cohort comprised 107 preterm children, 63 with NC and 44 control subjects without NC who were matched for gender, gestational age and birth weight. Kidney function was estimated based on measurements of serum creatinine (Scr), estimated glomerular filtration rate (eGFR), fractional excretion (FE) of sodium (Na), potassium (K), phosphate (P), magnesium (Mg) and uric acid (UA) and on the ratios of urinary Ca, oxalate (UOx) and citrate (UCit) to urinary creatinine (UCa/Ucr, UOx/Ucr and UCit/Ucr, respectively) calculated from morning urine collections. KL was measured by ultrasonography. Measurements were made at 40 weeks postmenstrual age and at 3, 6, 12 and 24 months of age. At 3 and 6 months, the NC group had higher UCa/Ucr, FEK and FEUA than the control group; at 12 months, only the UCa/Ucr and FEUA was still higher. The UCa/UCit ratio was higher in the NC group. Scr and eGFR did not differ between the groups at any time point. The NC group had a shorter KL up to 12 months of life (left kidney) or 24 months (right kidney). Based on these results, we conclude that NC in the preterm infants enrolled in our study was associated with impaired renal tubular function and a shorter KL in the first year of life.
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Affiliation(s)
- Vasileios Giapros
- Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece.
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