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Atypical idiopathic hypercalciuria in an adolescent
1Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington 98431-5406.
Summary
Idiopathic hypercalciuria (IH) can cause urolithiasis in adults and children. A thiazide trial proved diagnostic for IH in an adolescent presenting with atypical urinary chemistry, highlighting its value in unexplained symptoms.
Area of Science:
- Nephrology
- Urology
Background:
- Idiopathic hypercalciuria (IH) is a known cause of urolithiasis (kidney stones).
- Symptoms vary between adults and children, including hematuria, renal colic, and urinary tract infections.
Observation:
- This report details an adolescent with hematuria and flank pain.
- Urinary chemistry was not consistently indicative of IH.
- A diagnostic challenge involving thiazide medication and its withdrawal was employed.
Findings:
- The thiazide trial successfully diagnosed IH in the adolescent.
- The patient's presentation mimicked prepubertal IH despite being an older adolescent.
- Standard urinary calcium-creatinine ratios and timed urinary calcium levels can be equivocal in diagnosing IH.
Implications:
- Adolescents with unexplained urinary symptoms warrant evaluation for IH.
- A thiazide trial can be a valuable and cost-effective diagnostic tool for IH when other tests are inconclusive.
- Early diagnosis and management of IH can prevent stone formation and associated complications.