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Idiopathic hypercalciuria associated with hyperreninemia and high urinary prostaglandin E
Insights
Prostaglandin E (PGE) may contribute to idiopathic hypercalciuria in some children. Reducing PGE levels with medication decreased urinary calcium excretion, suggesting a link between PGE and renal calcium handling.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Renal Physiology
Background:
- Idiopathic hypercalciuria is a common cause of nephrolithiasis in children.
- Bartter syndrome is a group of inherited salt-losing tubulopathies with renal calcium wasting.
- The role of prostaglandins in idiopathic hypercalciuria remains unclear.
Observation:
- A child presented with idiopathic hypercalciuria and features suggestive of Bartter syndrome.
- Excessive urinary prostaglandin E (PGE) excretion and a renal calcium leak were observed.
- The patient's condition involved significant daily calcium excretion.
Findings:
- Treatment with aspirin and indomethacin, which inhibit prostaglandin synthesis, reduced urinary PGE excretion.
- This reduction in PGE was associated with a decrease in daily urinary calcium excretion.
- At the lowest PGE levels, the renal calcium leak resolved, though mild hypercalciuria persisted.
Implications:
- Prostaglandin E may play a significant role in the pathophysiology of idiopathic hypercalciuria in certain pediatric cases.
- Targeting prostaglandin synthesis could be a therapeutic strategy for managing hypercalciuria.
- Further research is warranted to elucidate the precise mechanisms linking PGE to renal calcium handling.
Abstract:
A patient with idiopathic hypercalciuria and some features suggestive of Bartter syndrome is reported. Excessive urinary prostaglandin E (PGE) excretion and renal calcium leak were documented in this child. Treatment with aspirin and indomethacin reduced urinary PGE excretion and was associated with a decrease in daily calcium excretion. At the lowest levels of urinary PGE, the renal calcium leak was no longer evident although mild hypercalciuria persisted. These results suggest that PGE may play a role in some cases of idiopathic hypercalciuria.