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Hypercalciuria in chronically institutionalized bedridden children: frequency, predictive factors and response to
Insights
Hypercalciuria (high urinary calcium) is common in bedridden children with neurologic disorders, increasing fracture risk. Treatment with thiazides effectively reduced urinary calcium levels.
Area of Science:
- Pediatric Nephrology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Chronic immobilization in children with neurologic disorders is associated with potential metabolic complications.
- Hypercalciuria, elevated urinary calcium excretion, is a recognized concern in various pediatric populations.
Purpose of the Study:
- To investigate the prevalence of hypercalciuria in chronically institutionalized, bedridden children with neurologic disorders.
- To explore the association between hypercalciuria and bone health, specifically limb fractures.
- To evaluate the efficacy of hydrochlorothiazide-amiloride treatment in reducing urinary calcium excretion.
Main Methods:
- Analysis of urine calcium and creatinine ratios (UCa/UCr) in 42 institutionalized children (ages 2-16).
- Comparison of hypercalciuric and normocalciuric groups regarding clinical and demographic factors.
- Assessment of limb fracture incidence in both groups over three years.
- Intervention with hydrochlorothiazide-amiloride for three weeks in hypercalciuric children.
Main Results:
- Hypercalciuria (UCa/UCr > 0.21) was identified in 42.8% of the children.
- Hypercalciuric children experienced a significantly higher incidence of limb fractures (p < 0.02).
- Treatment with hydrochlorothiazide-amiloride reduced mean UCa/UCr by 57.7% (p < 0.005), with only four children remaining hypercalciuric.
Conclusions:
- Resorptive hypercalciuria is prevalent in chronically immobilized, bedridden children with neurologic disorders.
- Screening for hypercalciuria is crucial due to its link with impaired bone metabolism and increased fracture risk.
- Thiazide-based therapy is an effective strategy for managing hypercalciuria and potentially reducing morbidity in this vulnerable pediatric population.
Abstract:
Calcium and creatinine concentrations were analyzed in urine samples of 42 chronically institutionalized bedridden children, with neurologic disorders. Their ages ranged from 2 to 16 (mean 8.7) years. Hypercalciuria, defined as UCa/UCr ratio greater than 0.21, was recognized in 18 children (42.8%), the mean UCa/UCr ratio of this group was 0.40 +/- 0.18. Twenty-four children were normocalciuric, with a mean UCa/UCr ratio of 0.08 +/- 0.03. There were no significant differences between the two groups with regard to age, sex, length of institutionalization, the basic neurologic disorder, diet, anticonvulsive medications, exposure to sunlight and weekly hours of physiotherapy. Age- and sex-matched percentiles for fat and muscle areas were similar in both groups. Seven limb fractures had occurred in the hypercalciuric group during the last three years, but only in one of the normocalciuric patients (p less than 0.02). The hypercalciuric children were treated with a hydrochlorothiazide-amiloride preparation for three weeks, which resulted in reduction of their mean UCa/UCr ratio by 57.7%, to 0.17 +/- 0.13 (p less than 0.005); only four children remained hypercalciuric. We conclude that resorptive hypercalciuria is common among chronically immobilized bedridden children. Hypercalciuria in such children should be specifically looked for, because of its association with deranged bone metabolism and increased frequency of limb fractures. Treatment with thiazides was found to be efficient in reducing urinary calcium excretion in our hypercalciuric patients. This therapeutic modality for the reduction of morbidity in bedridden chronically immobilized children should be further explored.