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Urinary calcium and uric acid excretion in children with vesicoureteral reflux
Abbas Madani1, Nooshin Kermani, Neamatollah Ataei
1Department of Pediatric Nephrology, Children's Hospital Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Children with vesicoureteral reflux (VUR) show higher rates of hypercalciuria and hyperuricosuria, increasing their risk for kidney stones. Early detection and intervention are key for preventing stone formation in pediatric VUR patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Urolithiasis is common in children, with vesicoureteral reflux (VUR) being a frequent predisposing factor.
- Pathophysiology of VUR-associated urolithiasis involves urinary tract infections, stasis, and metabolic derangements like crystallurias.
- Limited research exists on urinary calcium and uric acid excretion in pediatric VUR patients.
Purpose of the Study:
- To investigate the frequency of hypercalciuria and hyperuricosuria in children with VUR.
- To compare urinary calcium and uric acid excretion in VUR patients versus a healthy control group.
- To explore potential correlations between VUR severity and metabolic derangements.
Main Methods:
- Study included 108 children with VUR and 110 healthy controls.
- Fasting urine samples were analyzed for calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios.
- Statistical analysis compared metabolic parameters between VUR patients and controls.
Main Results:
- Hypercalciuria was significantly more prevalent in the VUR group (21.3%) compared to controls (3.6%).
- Mean Ca/Cr and UA/Cr ratios were significantly higher in VUR patients.
- A notable association of urinary stones and microlithiasis was observed in 29.6% of the VUR group.
Conclusions:
- Pediatric patients with VUR exhibit a higher incidence of hypercalciuria and hyperuricosuria.
- These findings highlight the importance of metabolic evaluation in children with VUR to guide stone prevention strategies.
- Understanding these relationships can enhance preventive and therapeutic interventions for urolithiasis in VUR.
Abstract:
Urolithiasis is relatively common in children, and identifiable predisposing factors for stone formation, including metabolic and structural derangements, can be established in most cases. Vesicoureteral reflux (VUR) is a common cause of kidney stone formation. The pathophysiological mechanism of urolithiasis in reflux is related to urinary tract infection and urinary stasis, both of which promote urinary crystal formation, but metabolic causes, such as crystallurias (mostly hypercalciuria), may also be involved in this process. However, few studies on urinary calcium and uric acid excretion in children with VUR have been conducted. We have studied the frequency of hypercalciuria and hyperuricosuria in children with VUR and compared the results with those from a control group. The VUR group comprised 108 children with VUR (19 boys, 89 girls; age range 3 months to 12 years), and the control group comprised 110 healthy children without any history of reflux or urinary tract infection (30 boys, 80 girls; age range 2 months to 12 years). Fasting urine was analyzed for the calcium/creatinine (Ca/Cr) and uric acid/creatinine (UA/Cr) ratios. Hypercalciuria was more frequently diagnosed in the VUR patients than in the control group (21.3 vs. 3.6%; P = 0.0001). Significant differences between the two groups were also found for the mean Ca/Cr and UA/Cr ratios (P = 0.0001 and P = 0.0001, respectively). No differences were found in the urinary Ca/Cr or UA/Cr ratios related to VUR grading or unilateral/bilateral VUR in the patient group, with the exception of those for hypercalciuria and mild VUR (P = 0.03). The association of urinary stones and microlithiasis in the VUR group was 29.6%. Our results demonstrate that the frequency of hypercalciuria and hyperuricosuria was higher in pediatric patients with VUR than in healthy children. Knowing this relationship, preventive and therapeutic interventions for stone formation in VUR could be greatly expanded.
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