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Low-dose thiazide diuretics in children with idiopathic renal hypercalciuria
Ji Na Choi1, Jae Seung Lee, Jae Il Shin
1Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
Insights
Low-dose hydrochlorothiazide effectively treats idiopathic renal hypercalciuria in children, reducing urinary calcium excretion and resolving symptoms like hematuria and urolithiasis. Treatment is generally safe and well-tolerated.
Area of Science:
- Pediatric Nephrology
- Pharmacology
Background:
- Idiopathic renal hypercalciuria is a common cause of urolithiasis and hematuria in children.
- Effective management strategies are crucial to prevent recurrent stone formation and renal damage.
Purpose of the Study:
- To evaluate the therapeutic efficacy and safety of hydrochlorothiazide in pediatric patients with idiopathic renal hypercalciuria.
Main Methods:
- Retrospective analysis of 28 children diagnosed with idiopathic renal hypercalciuria between 1991 and 2008.
- Hydrochlorothiazide dosage initiated at 0.5 mg/kg/day, with adjustments for non-responders to achieve hypocalciuria (urinary calcium/creatinine < 0.2 mg/mg).
Main Results:
- Hydrochlorothiazide (0.5 mg/kg/day) reduced urinary calcium excretion in 89% of patients.
- Associated symptoms like gross/microscopic hematuria and urolithiasis showed gradual resolution.
- Treatment discontinuation led to relapse in 42% of patients, necessitating retreatment.
Conclusions:
- Low-dose hydrochlorothiazide (0.5 mg/kg/day) is a safe and effective treatment for pediatric idiopathic renal hypercalciuria.
- Long-term management may be required due to potential relapse after discontinuation.
Aim:
To evaluate the therapeutic effect of hydrochlorothiazide in idiopathic renal hypercalciuria.
Methods:
We retrospectively analysed the data of 28 children (6.0±4.1 years, M:F=19:9) diagnosed as having idiopathic renal hypercalciuria from the years 1991 to 2008. The dose of hydrochlorothiazide was initially 0.5 mg/kg/day and gradually increased to achieve the appropriate hypocalciuric effect (urinary calcium/creatinine<0.2 mg/mg) in some unresponsive patients.
Results:
Twenty-two patients (79%) had gross haematuria, 6 (21%) microscopic haematuria, 2 left flank pain, 6 (21%) urolithiasis and 9 (32%) urinary tract infection at the diagnosis of hypercalciuria. The low doses (0.5 mg/kg/day) of hydrochlorothiazide reduced urinary calcium excretion in 25 patients (89%) and 3 (11%) required the increased doses (1-2 mg/kg/day). Haematuria and urolithiasis gradually resolved in accordance with the improvement of hypercalciuria. Nineteen patients (68%) maintaining hypocalciuria during hydrochlorothiazide therapy were discontinued after 12.5±5.3 months of treatment. Eleven of the 19 patients maintained normocalciuria, while 8 showed increased urinary calcium excretion at 2.9±2.3 months after treatment was stopped, requiring thiazide retreatment.
Conclusion:
Our results suggest that low dose (0.5 mg/kg/day) of hydrochlorothiazide may be safe and effective in controlling renal hypercalciuria in children.
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