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Hematuria and hypercalciuria in children with diabetes mellitus
Insights
Diabetic children often experience hematuria due to hypercalciuria, a condition where excess calcium is excreted in urine. This study highlights hypercalciuria as a significant risk factor for kidney damage in pediatric diabetes patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Diabetology
Background:
- Hematuria (blood in urine) is a common but often unexplained symptom in patients with diabetic nephropathy.
- In non-diabetic individuals, hypercalciuria (elevated urinary calcium) can lead to kidney stones and hematuria.
- Eight children with type I diabetes, hematuria, and hypercalciuria were identified, with two also showing signs of renal papillary necrosis.
Purpose of the Study:
- To investigate the role of hypercalciuria in the development of hematuria among children with type I diabetes mellitus.
- To compare urinary calcium excretion levels between diabetic and non-diabetic children.
- To assess the prevalence of hypercalciuria in pediatric diabetes patients.
Main Methods:
- Measurement of urinary calcium to creatinine ratio in a cohort of children with type I diabetes.
- Comparison of urinary calcium levels with a control group of non-diabetic children.
- Establishment of a normal range for urinary calcium to creatinine ratio in the non-diabetic population.
Main Results:
- Diabetic children exhibited a significantly higher urinary calcium to creatinine ratio (0.21 ± 0.01) compared to non-diabetic children (0.12 ± 0.01).
- Using a threshold of 0.28, 27% of the diabetic children were identified as hypercalciuric.
- Hypercalciuric diabetic children also showed hyperphosphaturia and a threefold higher urinary CaHPO4 molar ion product than controls.
Conclusions:
- Hypercalciuria is prevalent in children with type I diabetes and may contribute to renal damage.
- The increased incidence of hypercalciuria in diabetic children suggests a potential link to diabetic nephropathy.
- Hypercalciuria may play a previously unrecognized role in the renal complications associated with pediatric diabetes.
Abstract:
Hematuria of unknown origin occurs in 30% of patients with diabetic nephropathy. In nondiabetic persons, hematuria may be caused by hypercalciuria with or without nephrolithiasis. Eight children with type I diabetes mellitus, hematuria, and hypercalciuria were observed in our clinic during a 1-year period. Two of these also had evidence of renal papillary necrosis. To assess the importance of hypercalciuria in the pathogenesis of hematuria in children with diabetes mellitus, we measured urinary calcium excretion in a large population of such patients. The calcium to creatinine ratio in the urine of diabetic children (0.21 +/- 0.01) was greater than that of nondiabetic children (0.12 +/- 0.01). A calcium to creatinine ratio of 0.28 was established as the upper limit of normal in our nondiabetic population, and 27% of the diabetic children were hypercalciuric on this basis. The diabetic children with hypercalciuria also had hyperphosphaturia and a urinary CaHPO4 X 2H2O molar ion product three times that found in the nondiabetic control population. These data suggest that many children with diabetes are at risk for renal damage due to hypercalciuria. Because hypercalciuria is more common in diabetic than nondiabetic children, it may play a previously unrecognized role in the renal disease associated with diabetes mellitus.