Kidney Stones as an Underrecognized Clinical Sign in Pediatric Cushing Disease

Area of Science:

• Pediatric Endocrinology
• Nephrology
• Urology

Background:

• Cushing disease (CD) is a rare endocrine disorder in children.
• Kidney stones (nephrolithiasis) are a known complication of hypercortisolism.
• The prevalence of kidney stones in pediatric CD is not well-established.

Purpose of the Study:

• To determine the prevalence of kidney stones in children diagnosed with Cushing disease.
• To compare the incidence of kidney stones in pediatric CD patients with that of healthy children.

Main Methods:

• Retrospective analysis of clinical and biochemical data from 139 pediatric patients with CD.
• Review of computed tomography (CT) scans for radiographic evidence of kidney stones.
• Comparison of stone prevalence between CD patients and a general pediatric population.

Main Results:

• Kidney stones were identified in 27 out of 139 pediatric CD patients (19.4%).
• Children with kidney stones had higher urine free cortisol levels and underwent transsphenoidal surgery at a later age.
• The average urinary calcium/creatinine ratio was elevated in CD patients (0.22 ± 0.11).
• The prevalence of kidney stones in children with CD (19.4%) was significantly higher than in healthy children (1.0%; P < .001).

Conclusions:

• Kidney stones represent an underestimated complication in pediatric Cushing disease.
• The significantly higher prevalence in CD patients warrants increased clinical vigilance.
• Further research is needed to understand the long-term impact on kidney function.