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An Important Risk Factor Affecting Hypercalciuria in Children: Vesicoureteral Reflux
Hakan Bahadir Haberal1, Meylis Artykov1, Berk Hazir1
1Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
Insights
Vesicoureteral reflux (VUR) in children is linked to higher urinary calcium excretion, especially in untreated cases. Treatment of VUR significantly lowers calcium levels, similar to healthy children.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Nephrology
Background:
- Hypercalciuria in children is influenced by genetic and environmental factors, including diet.
- Vesicoureteral reflux (VUR) is a condition that affects the urinary tract in children.
Purpose of the Study:
- To investigate the relationship between the presence and severity of VUR and hypercalciuria in pediatric patients.
- To compare urinary calcium excretion levels in children with VUR, urinary stones, and healthy controls.
Main Methods:
- Retrospective analysis of data from 165 pediatric patients.
- Patients were categorized into four groups: urinary stone, VUR follow-up, corrected VUR, and control.
- Demographic, clinical, and laboratory data were compared across groups.
Main Results:
- Children with urinary stones and those with VUR under follow-up exhibited significantly higher urinary calcium/creatinine (UCa/Cr) ratios compared to the corrected VUR group.
- Urinary calcium excretion levels in the corrected VUR group were comparable to the control group.
- In the VUR follow-up group, higher-grade reflux correlated with increased mean UCa/Cr excretion and a higher frequency of elevated UCa/Cr ratios.
Conclusions:
- VUR treatment is associated with a significant reduction in urinary calcium excretion, normalizing levels to those seen in the general pediatric population.
- Children with untreated VUR show elevated urinary calcium levels, similar to those with urinary stones.
- The degree of VUR positively correlates with urinary calcium excretion.
Introduction:
A large number of genes and environmental factors, like dietary habits, play a role in the development of hypercalciuria in children. In this study, we aimed to determine the effects of the presence and grade of vesicoureteral reflux (VUR) on hypercalciuria status in children.
Materials And Methods:
Data for 165 patients who admitted to the Pediatric Urology Department were retrospectively analyzed. The patients were composed of following four different groups: (1) urinary stone patients, (2) VUR patients under follow-up, (3) corrected VUR patients, and (4) control. The demographic features, clinical data, and laboratory tests for the groups were compared.
Results:
The mean age of the patients was 100.6 ± 54.69 months and the female/male ratio was 79:86. The mean urinary calcium/creatinine (UCa/Cr) excretion and the frequency of high UCa/Cr ratios in the corrected VUR group were similar to those in the control group (p = 0.375 and 0.965, respectively). In contrast, the mean UCa/Cr excretion and frequency of high UCa/Cr ratios in the urinary stone and follow-up VUR groups were significantly higher than those in the corrected VUR group (p < 0.001, < 0.001, 0.003, and 0.029, respectively). The mean UCa/Cr excretion and frequency of high UCa/Cr ratios in the follow-up VUR group were similar to those in the urinary stone group (p = 0.323 and 0.425, respectively). In the follow-up VUR group, although reflux laterality had no effect on the UCa/Cr ratios (p = 0.180 and 0.108, respectively), the mean and frequency of high UCa/Cr ratios were higher in high-grade reflux cases (p < 0.001 and p = 0.042, respectively).
Conclusion:
Both the mean UCa/Cr ratio and the rate of hypercalciuria in the corrected reflux group were significantly lower than the corresponding values in the follow-up VUR and urinary stone groups. Further, the follow-up VUR patients had similar urinary calcium excretion levels as the stone patients. VUR treatment is associated with a decrease in urinary calcium excretion to the normal population level. A positive correlation between reflux degree and calcium excretion was observed.
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