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Hypercalciuria in clinical pediatrics. A review
Insights
Idiopathic hypercalciuria in children causes urinary issues like hematuria and enuresis. Screening involves urine calcium-creatinine ratio, with specific treatment for identified causes and thiazide diuretics for kidney stones.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Idiopathic hypercalciuria (IH) is a common metabolic abnormality in children.
- IH can manifest with diverse urinary tract symptoms, including hematuria, enuresis, and renal calculi.
- Early diagnosis and management are crucial for preventing long-term complications.
Purpose of the Study:
- To review the clinical presentation and diagnostic approaches to idiopathic hypercalciuria in pediatric patients.
- To outline management strategies for IH, focusing on identified causes and renal stone management.
- To discuss the controversies surrounding pharmacotherapy for non-calculi related symptoms in pediatric IH.
Main Methods:
- Literature review of idiopathic hypercalciuria in pediatric populations.
- Analysis of diagnostic tools, including urine calcium-creatinine ratio.
- Evaluation of treatment guidelines for IH and associated urinary tract complaints.
Main Results:
- A random urine calcium-creatinine ratio serves as an effective initial screening tool for hypercalciuria.
- Specific treatment is indicated for identifiable causes of hypercalciuria.
- Thiazide diuretics are the recommended treatment for uncomplicated renal calculi in children with IH.
Conclusions:
- Idiopathic hypercalciuria presents with varied urinary symptoms in children.
- A stepwise diagnostic approach, starting with urine calcium-creatinine ratio, is recommended.
- Pharmacological treatment for IH symptoms beyond renal stones should be reserved for severe cases.
Abstract:
Idiopathic hypercalciuria is a cause of a variety of urinary tract complaints in clinical pediatrics. These include gross or microscopic hematuria, enuresis, urinary frequency or urgency, dysuria, sterile pyuria, and proteinuria in addition to renal calculi. A random urine calcium-creatinine concentration ratio can be used to initially screen for hypercalciuria. Patients with indeterminate results should have the test repeated, while those with abnormal values should receive a complete metabolic workup to determine the cause of hypercalciuria. Identifiable causes of hypercalciuria should be treated specifically, and thiazide diuretics are the preferred treatment for uncomplicated renal calculi. Pharmacotherapy in children with idiopathic hypercalciuria and symptomatology other than renal stones is controversial and should be limited to patients with severe clinical manifestations.