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Carbohydrate intolerance and kidney stones in children in the Goldfields
D N Baldwin1, J L Spencer, C A Jeffries-Stokes
1University of Western Australia, Department of Paediatrics, Rural Paediatric Unit, Kalgoorlie, Western Australia, Australia.
Insights
Renal stones (nephrolithiasis) are common in Aboriginal children, often urate-based. Lactose intolerance may cause metabolic acidosis, leading to kidney stones and potential chronic kidney disease.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Public Health
Background:
- Renal stones (nephrolithiasis) are a recognized health issue in Australian Aboriginal children, predominantly composed of urate.
- Chronic kidney disease (CKD) disproportionately affects Aboriginal Australians, with end-stage renal failure incidence 13 times higher than non-Aboriginals.
Observation:
- A study in Western Australia identified five children under five years old with nephrolithiasis.
- All five children diagnosed with kidney stones also presented with lactose intolerance.
Findings:
- The researchers postulate that carbohydrate malabsorption, leading to chronic diarrhea and bacterial sugar breakdown, can cause metabolic acidosis.
- Metabolic acidosis may contribute to protein catabolism, increased urate excretion, and subsequent renal stone formation.
Implications:
- Carbohydrate intolerance is proposed as a potential etiological factor in pediatric renal stones and chronic kidney disease among Aboriginal Australians.
- Early identification and management of carbohydrate intolerance could be crucial for preventing kidney disease progression in at-risk children.
Abstract:
Renal stones have been reported as a common finding in Australian Aboriginal children. The stones are predominantly urate in composition. We report on five children with nephrolithiasis from the Goldfields region of Western Australia. All were diagnosed when under 5 years of age, the majority being under 3 years. All five children also had lactose intolerance, and we postulate that carbohydrate malabsorption, together with the ensuing chronic diarrhoea and intraluminal breakdown of sugars by enteric bacteria may result in a situation of chronic metabolic acidosis. Chronic metabolic acidosis can lead to protein catabolism, increased urate excretion and the formation of renal stones. Carbohydrate intolerance may be an aetiological factor in the development of renal stones and possibly chronic renal disease, particularly in Aboriginal Australians. Renal disease represents one of the most significant factors affecting the health of Australian Aboriginal people. The incidence of end stage renal failure in this population exceeds that of non-Aboriginals by a factor of 13:1, and this disproportionate figure is increasing. It is likely that chronic renal damage is multifactorial; however, it is probable that at least some aetiological factors have their onset during childhood.