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Urinary tract infection in children associated with idiopathic hypercalciuria
P Vachvanichsanong1, M Malagon, E S Moore
1Department of Pediatrics, University of Tennessee Graduate School of Medicine, Knoxville, USA. vprayong@ratree.psu.ac.th
Insights
Symptomatic non-calculous idiopathic hypercalciuria (IH) is linked to urinary tract infections (UTI) in children. This study suggests IH may contribute to recurrent UTIs, impacting pediatric urology.
Area of Science:
- Pediatric Nephrology
- Urology
- Internal Medicine
Background:
- Idiopathic hypercalciuria (IH) is a common metabolic abnormality in children.
- The association between non-calculous IH and urinary tract infections (UTI) remains unclear.
- Understanding this link is crucial for effective pediatric UTI management.
Purpose of the Study:
- To investigate the relationship between symptomatic non-calculous idiopathic hypercalciuria (IH) and the occurrence of UTI in pediatric patients.
- To determine if IH is a significant risk factor for recurrent UTIs in children.
Main Methods:
- Retrospective case review of 124 children with elevated urinary calcium excretion.
- Analysis of urinary calcium-creatinine ratios (UCa/UCr) and 24-hour urine calcium levels.
- Comparison of demographic and clinical data between children with and without UTI.
Main Results:
- 40% of children reviewed had a UTI, with 78% experiencing recurrent UTI.
- No significant differences in age, 24-hour urine calcium, or random UCa/UCr were found between groups.
- Hematuria, abdominal pain, and urinary incontinence were common; 15% of recurrent UTI cases had urinary tract abnormalities.
Conclusions:
- Non-calculous idiopathic hypercalciuria (IH) is proposed as a potential contributing factor to recurrent urinary tract infections (UTI) in children.
- Further research is warranted to elucidate the mechanisms linking IH and pediatric UTIs.
- Management strategies may need to consider IH in children with recurrent UTIs.
Objective:
The aim of this study was to evaluate the association of symptomatic non-calculous idiopathic hypercalciuria (IH) with urinary tract infection (UTI) in children.
Material And Methods:
This was a retrospective case review of children who had urinary calcium excretion greater than 2 mg/kg/day or random urine calcium-creatinine ratio (UCa/UCr) greater than 0.18 mg/mg.
Results:
One hundred and twenty-four consecutive children with clinical complaints and elevated urine calcium excretion were reviewed. Fifty children (40%) had UTI of which 39 (78%) had recurrent UTI. There was no difference in age between children with UTI and those without UTI. Twenty-four-hour urine calcium and random UCa/UCr were also not different. Only 4 children (8%) had renal stones whereas hematuria, abdominal pain and urine incontinence were frequent associated findings. Six of the children with recurrent UTI (15%) had an anatomical urinary tract abnormality. Therapy in all children consisted of increased fluid intake and reduction in diet sodium and oxalate; however, 14 of the 39 children with recurrent UTI (36%) required therapy with a thiazide diuretic. Recurrent UTI was abolished in 24 children, one child had a single recurrence and 4 children had no response to treatment.
Conclusions:
We propose that non-calculous IH may be an important contributing factor to recurrent UTI in children.