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Urinary calcium excretion in children with vesicoureteral reflux
Víctor García-Nieto1, Beatriz Siverio, Margarita Monge
1Pediatric Nephrology Unit, Nuestra Señora de Candelaria University Hospital, Carretera del Rosario, Santa Cruz de Tenerife, Spain. vgarcia@comtf.es
Insights
Children with vesico-ureteral reflux (VUR) show a higher prevalence of hypercalciuria, often inherited from parents. This metabolic origin suggests a link between VUR, hypercalciuria, and urolithiasis in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Genetics
Background:
- Renal malformations, including vesico-ureteral reflux (VUR), are linked to urolithiasis.
- Urinary calcium excretion studies in pediatric VUR patients are scarce.
Purpose of the Study:
- To investigate the prevalence of hypercalciuria in children with VUR.
- To determine if family members of these children have hypercalciuria or a history of urolithiasis.
Main Methods:
- Studied 46 children diagnosed with VUR.
- Assessed hypercalciuria using Stapleton's criteria.
- Evaluated urolithiasis and family history in parents and relatives.
Main Results:
- 58.6% of children with VUR exhibited hypercalciuria.
- Children with hypercalciuria were shorter and had lower maximal urinary osmolality.
- Hypercalciuria and urolithiasis were prevalent in parents and relatives, suggesting an inherited trait.
Conclusions:
- Paediatric VUR patients have a higher prevalence of hypercalciuria than the general population.
- Urolithiasis in VUR patients appears to have a metabolic basis.
- Hypercalciuria in this cohort demonstrated autosomal dominant inheritance, with a higher likelihood of maternal transmission.
Background:
Renal malformations including vesico-ureteral reflux (VUR) are associated with urolithiasis. However, studies on urinary calcium excretion in children with VUR have not been reported. This study was conducted to find out whether children with VUR have a higher prevalence of hypercalciuria and whether their family members are affected by hypercalciuria and/or urolithiasis.
Methods:
We studied the prevalence of hypercalciuria and urolithiasis in 46 children (12 males and 34 females) with VUR and in their parents.
Results:
Three out of 46 children had renal colic and nine out of 46 exhibited calyceal microlithiasis in the renal sonography. According to Stapleton's criteria, we found that 27 out of 46 children (58.6%) had hypercalciuria. These children were significantly shorter than children with normal calciuria and showed lower values of maximal urinary osmolality. We found no differences in urinary calcium excretion values related to the VUR grading, or to the presence or absence of renal scars, or to whether VUR was still unresolved or already resolved at the time of study. Seventeen out of 27 children with hypercalciuria (63%) had one or both parents affected by hypercalciuria, and there was a history of urolithiasis in six first-degree relatives and in four second-degree relatives (37%). Besides, 10 out of 19 children without hypercalciuria (52.6%) had one or both parents affected by hypercalciuria and there was a history of urolithiasis in three first-degree relatives and in three second-degree relatives (31.6%). Among the 27 children whose parents had hypercalciuria, four had both parents affected, 19 had only the mother affected and in four patients only the father was affected.
Conclusion:
Our results showed that the prevalence of hypercalciuria was greater in paediatric patients with VUR than in the general population. Urolithiasis in patients with VUR had a metabolic origin. Hypercalciuria was inherited as an autosomal dominant trait although with a higher probability to be inherited from the mother.