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Should pediatric idiopathic hypercalciuria be treated with hypocalciuric agents?
Maria Goretti Moreira Guimarães Penido1, Marcelo de Sousa Tavares2
1Pediatric Nephrology Unit, Nephrology Center of Santa Casa de Belo Horizonte, Belo Horizonte 30150320, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br.
World Journal of Nephrology
|August 25, 2021
Summary
Thiazide treatment improved bone mineral density in children with idiopathic hypercalciuria (IH) who did not respond to lifestyle changes. This suggests thiazides may be beneficial for bone health in pediatric IH patients.
Area of Science:
- Pediatric Nephrology
- Metabolic Bone Disease
- Urolithiasis Research
Background:
- Idiopathic hypercalciuria (IH) is a key risk factor for calcium urolithiasis and is linked to reduced bone mineral density (BMD) in children.
- The long-term impact of lifelong hypercalciuria on bone mass acquisition and structure in pediatric populations remains unclear.
- Previous studies suggest potential benefits of citrate and thiazide therapies on bone health in IH patients.
Purpose of the Study:
- To investigate the effect of pharmacological therapy on bone mass in children and adolescents diagnosed with IH.
- To assess whether specific treatments can mitigate bone loss or improve bone mass accrual in pediatric IH.
Main Methods:
- Retrospective cohort study of 40 pediatric patients with IH unresponsive to diet and lifestyle modifications.
- Initial 2-month treatment with potassium citrate (Kcitrate), followed by dual-energy X-ray absorptiometry (DXA) for bone densitometry.
- Addition of thiazide diuretic for patients with persistent hypercalciuria, with a second DXA performed after 12 months.
- Collection of 24-hour urine and blood samples for biochemical analysis, alongside clinical data.
Main Results:
- Forty pediatric patients with IH (median age 10.5 years) were evaluated, with 9 on Kcitrate alone (G1) and 31 on Kcitrate plus thiazide (G2).
- Both treatment groups showed a decrease in calciuria; however, only the thiazide group (G2) demonstrated a significant increase in lumbar spine BMD z-score.
- No adverse effects on total cholesterol, kalemia, or magnesemia were observed. G1 showed no BMD improvement.
Conclusions:
- Thiazide therapy demonstrates a beneficial effect on lumbar spine bone mineral density z-score in children with idiopathic hypercalciuria.
- These findings suggest thiazides as a potential therapeutic option for improving bone health in pediatric IH.
- Further research is warranted to validate these results and elucidate the underlying mechanisms.
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