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Recurrent abdominal and flank pain in children 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
Idiopathic hypercalciuria (IH) is a potential cause of recurrent abdominal pain (RAP) in children. Early consideration of IH in pediatric RAP diagnosis can lead to effective treatment.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Gastroenterology
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint with diverse etiologies.
- Idiopathic hypercalciuria (IH), characterized by elevated urinary calcium excretion, is increasingly recognized in children.
Observation:
- This retrospective study reviewed 124 children with elevated 24-h urine calcium excretion or random urine calcium-creatinine ratio.
- Fifty-two children presented with RAP or flank pain, with 50% having a family history of urolithiasis.
- Associated symptoms included hematuria (27 children) and urinary incontinence (10 children).
Findings:
- Of the 52 children with RAP, 6 had renal stones; however, IH was identified as the likely cause.
- Biochemical abnormalities noted were mild metabolic acidosis (3), elevated parathyroid hormone (2), and increased vitamin D (9).
- Treatment involving fluid intake, dietary modification, thiazides, and antispasmodics was effective in 45 out of 52 children.
Implications:
- Idiopathic hypercalciuria should be considered in the differential diagnosis of pediatric recurrent abdominal pain.
- Early identification and management of IH can improve outcomes for children experiencing RAP.
- This study highlights the significant prevalence of IH in children presenting with abdominal pain and related urinary symptoms.
Objective:
To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children.
Patients And Methods:
We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg.
Results:
Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 +/- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available.
Conclusion:
We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.
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