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Hyperuricosuria in children: clinical presentation and natural history
A La Manna1, C Polito, A Marte
1Department of Pediatrics, Second University of Naples, Naples, Italy.
Insights
Idiopathic hyperuricosuria (HU) and hypercalciuria can occur in children without hematuria. These conditions should be suspected in children with dysuria or abdominal pain, even without visible blood in urine, as it doesn't rule out urolithiasis.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Genetics
Background:
- Idiopathic hyperuricosuria (HU) is a metabolic condition affecting children, often associated with hematuria.
- Previous reports on HU primarily focused on children presenting with hematuria, limiting understanding of its broader clinical spectrum.
Purpose of the Study:
- To investigate the clinical presentation and natural history of idiopathic hyperuricosuria (HU) in children.
- To include children with dysuria, recurrent abdominal/flank pain, and a family history of urolithiasis, in addition to those with hematuria.
Main Methods:
- Retrospective analysis of 102 children diagnosed with HU.
- Outcome analysis of 26 children followed for at least one year without specific therapy.
Main Results:
- 61 children had HU, and 41 had HU with hypercalciuria.
- 52% of patients had microcalculi or calculi on renal sonography, despite lacking hematuria.
- 77% of children without initial hematuria showed evidence of microcalculi or calculi.
Conclusions:
- Absence of hematuria does not exclude urolithiasis in children with HU.
- Diagnosis of HU and hypercalciuria should be considered in children with dysuria or recurrent pain, even without hematuria.
- Evaluating therapeutic efficacy solely on hematuria resolution may be misleading.
Objective:
Idiopathic hyperuricosuria (HU) was previously reported in only a limited number of children with hematuria. We aimed to outline the clinical presentation and natural history of HU not only in children with hematuria, but also in those with dysuria and/or recurrent abdominal/flank pain and a family history of urolithiasis.
Study Design:
Retrospective analysis of data at diagnosis from 102 consecutive children with HU and outcome analysis of 26 of them who were followed >/=1 years (mean: 3.1) with no specific therapy.
Results:
Sixty-one participants had HU and 41 had HU + hypercalciuria. Fifty-two patients had no hematuria among the presenting symptoms, more than one third had normal urinalysis at our first examination, one half had microcalculi (<3 mm in diameter) at renal sonography, and 12% had stones (4-18 mm). Thirty participants of the 39 with no hematuria at our first examination (77%) showed microcalculi or calculi at renal sonography. The patients with microcalculi were significantly older than were those without microcalculi. During the follow-up, 4 of 26 children never had hematuria and 8 had no hematuria during most of the follow-up period. Two patients who had a calculus at first visit and 3 who formed calculi 4 to 12 mm in diameter, after 1 to 3.5 years subsequently passed them in the urine.
Conclusions:
The lack of hematuria is not predictive of absence of urolithiasis. Therefore, it may be misleading to judge on the efficacy of a given therapy only based on disappearance of hematuria. HU and hypercalciuria have to be suspected in children with dysuria and those with recurrent abdominal/flank pain and familial history of urolithiasis, although they have no hematuria.