Related Experiment Videos
Hypercalciuria and recurrent urinary tract infection in Venezuelan children
M M López1, L A Castillo, J B Chávez
1Equipex SA, Miami FL 33102-0010, USA. pliendo@reacciun.ve
Insights
Hypercalciuria, or high urinary calcium, may predispose children to recurrent urinary tract infections (UTIs). Treating hypercalciuria with dietary changes and medication successfully prevented further UTIs in 95% of children studied.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Recurrent urinary tract infections (UTIs) are common in children.
- Hypercalciuria is not widely recognized as a cause of recurrent UTIs in this population.
Purpose of the Study:
- To investigate the role of hypercalciuria in children with recurrent UTIs and a normal urinary tract.
- To evaluate the efficacy of treating hypercalciuria in preventing recurrent UTIs.
Main Methods:
- Studied 59 children with recurrent UTIs and hypercalciuria.
- Assessed clinical manifestations, urinary calcium/creatinine ratios, and renal function.
- Implemented treatment including fluid promotion, dietary modifications, and medications if needed.
Main Results:
- Hypercalciuria was confirmed with urinary calcium/creatinine ratios of 0.36+/-0.15 mg/mg.
- Treatment led to normocalciuria and resolution of recurrent UTIs in 95% of children.
- Potential mechanism involves microcrystal formation damaging the uroepithelium.
Conclusions:
- Hypercalciuria may predispose children to recurrent UTIs.
- Investigating urinary calcium excretion is recommended for children with recurrent UTIs and normal urinary tracts.
- Treatment normalizing urinary calcium levels is highly effective in preventing recurrence.
Abstract:
Recurrent urinary tract infection (UTI) has not been widely recognized as a clinical manifestation of hypercalciuria in children. We studied 59 children with two or more episodes of UTI, a normal urinary tract, and with hypercalciuria. Clinical manifestations were fever, dysuria, straining with micturition, hematuria, polyuria, abdominal pain, and failure to thrive. Urinary calcium/creatinine ratio was 0.36+/-0.15 mg/mg. Renal function studies included serum bicarbonate (21+/-3 mmol/l), urinary/blood PCO2 difference (11+/-11 mmHg), urinary net acid excretion (63+/-3 micromol/min per 1.73 m2), uric acid fractional excretion (13%+/-12%), and maximal urinary osmolality (920+/-236 mosmol/kg). Treatment included promotion of fluid intake, avoiding excessive salt and protein, and keeping dietary calcium between 900 and 1,200 mg/day. Potassium citrate or hydrochlorothiazide were indicated if hypercalciuria persisted. With this treatment, in 95% of the children, no further episodes of UTI occurred once normocalciuria was achieved. It is possible that hypercalciuria may play a predisposing role for recurrent UTI in children by promoting the formation of microcrystals which damage the uroepithelium. We advocate the investigation of urinary calcium excretion in children with recurrent UTI and a normal urinary tract.