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Idiopathic hypercalciuria in children. Classification, clinical manifestations and outcome
Insights
Idiopathic hypercalciuria (IH) in children is often benign, presenting with urinary tract infections or hematuria. Dietary response effectively classifies IH subtypes, aiding management.
Area of Science:
- Pediatric Nephrology
- Metabolic Disorders
- Urology
Background:
- Idiopathic hypercalciuria (IH) is a condition affecting children, characterized by elevated calcium levels in the urine.
- Understanding the subtypes and clinical presentation of IH is crucial for appropriate management.
- Previous diagnostic methods like Pak's test have limitations in differentiating IH subtypes.
Purpose of the Study:
- To classify idiopathic hypercalciuria in children based on their response to dietary manipulation.
- To compare the efficacy of dietary response versus Pak's test in classifying IH.
- To characterize the clinical presentation and familial prevalence of IH in a pediatric cohort.
Main Methods:
- A cohort of 49 children aged 2-15 years diagnosed with IH were studied.
- Children were divided into three groups based on urinary calcium excretion response to dietary changes: absorptive, renal, and sodium-dependent hypercalciuria.
- A control group of 45 healthy children provided baseline metabolic parameters.
- Clinical symptoms, familial history, and response to treatment were monitored.
Main Results:
- Dietary manipulation proved more reliable than Pak's test for classifying IH subtypes.
- The majority of IH children presented with gross hematuria and urinary tract infections (UTI), not urolithiasis.
- Clinical symptoms generally resolved with controlled urine calcium excretion.
- Severe calcium restriction led to osteoporosis and delayed bone age in some patients.
Conclusions:
- Idiopathic hypercalciuria in childhood is typically a benign condition.
- UTI and hematuria are common presenting symptoms of pediatric IH.
- A classification system based on dietary response offers a practical approach to managing IH in children.
Abstract:
Between 1981 and 1983, 49 children aged 2 to 15 years were diagnosed as having idiopathic hypercalciuria (IH). They were divided into 3 groups based on their response to dietary manipulation: group I (32/49) had absorptive hypercalciuria; group II (8/49) had renal hypercalciuria and group III (6/49) had sodium-dependent hypercalciuria. Response to diet was more reliable than Pak's test in differentiating between the three groups. A control group (CG) of 45 healthy, age matched children determined baseline levels for all metabolic parameters. At the time of presentation IH children did not differ from the CG in height or weight. Fifty percent of IH children had first degree relatives with urolithiasis. Yet, only 16% of the IH children had urolithiasis, the majority presenting with gross hematuria and urinary tract infections (UTI). With few exceptions the clinical symptoms resolved when urine calcium excretion was controlled. Severe calcium restriction in a few patients produced osteoporosis and delayed bone age although growth velocity was unaffected. Thiazide therapy in a few patients produced some metabolic derangements. The authors conclude that IH in childhood is a benign disease which may present with UTI or hematuria. They further propose a new classification method based on response to dietary manipulation.