Pediatric nephrolithiasis and the link to bone metabolism
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Published on: February 9, 2021
Andrew Lawrence Schwaderer1, Kirsten Kusumi, Rose Mary Ayoob
1aNationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Division of Nephrology bThe Research Institute at Nationwide Children's Hospital, Center for Clinical and Translational Medicine cPediatric Nephrology Fellowship, Nationwide Children's Hospital, Ohio, USA.
Insights
Pediatric nephrolithiasis (kidney stones) is linked to low bone mineral density (BMD), increasing fracture and osteoporosis risk. Early identification and treatment with citrate or thiazides may improve bone health in children.
Area of Science:
- Pediatric Nephrology
- Bone Metabolism
- Mineralocorticoid Receptor Antagonists
Background:
- Pediatric nephrolithiasis incidence is rising.
- Nephrolithiasis is associated with decreased bone mineral density (BMD) in children.
- Children with kidney stones face increased risks for fractures and osteoporosis.
Purpose of the Study:
- To review recent literature on the connection between pediatric nephrolithiasis and bone metabolism.
- To highlight the growing concern of low BMD in pediatric kidney stone patients.
- To explore potential therapeutic strategies for improving bone health in this population.
Main Methods:
- Literature review of recent publications.
- Analysis of studies examining pediatric nephrolithiasis and bone density.
- Synthesis of findings on contributing factors and treatment outcomes.
Main Results:
- Increasing pediatric nephrolithiasis is linked to low BMD.
- Factors beyond calcium metabolism, including inflammation, genetics, and diet, play a role.
- Retrospective data suggest citrate or thiazide treatment may improve BMD in affected children.
Conclusions:
- A significant relationship exists between pediatric nephrolithiasis and low BMD.
- Early identification and intervention are crucial for mitigating long-term bone health consequences.
- Citrate or thiazide therapy shows promise for improving BMD in at-risk pediatric patients.
Purpose Of Review:
To review the recent publications describing the link between pediatric nephrolithiasis and bone metabolism.
Recent Findings:
Nephrolithiasis incidence is increasing in children and is associated with low bone mineral density (BMD). Affected children are conceptually at risk for fractures and osteoporosis. In addition to abnormal calcium metabolism, inflammation, genetic makeup and dietary habits are being recognized as important factors in the pathophysiology of nephrolithiasis and low bone density. Findings from retrospective reviews suggest that low BMD in children may be improved with citrate or thiazide treatment.
Summary:
The healthcare burden from low BMD with subsequent osteoporosis and fracture risk is immense with potential far-reaching effects in patient quality of life and healthcare expense. Bone mass is acquired in the pediatric age range, thus it is important to identify and treat at-risk children. Retrospective reviews in pediatric patients indicate that citrate or thiazide diuretic treatment may improve BMD. We now understand that a relationship exists between nephrolithiasis and low BMD. To improve healthcare for our current patients as well as protect their future health it is important to identify low BMD and initiate strategies to improve BMD in 'at-risk' children.
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