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Hydrochlorothiazide treatment of children with hypercalciuria: effects and side effects
G S Reusz1, M Dobos, T Tulassay
1First Department of Paediatrics, Semmelweis University Medical School, Budapest, Hungary.
Insights
Hydrochlorothiazide treatment in children with renal hypercalciuria effectively reduced urinary calcium excretion. However, it also led to increased atherogenic cholesterol fractions, raising concerns about long-term safety.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Cardiovascular Risk Factors
Background:
- Renal hypercalciuria is a condition characterized by excessive calcium excretion in the urine.
- Hypercalciuria in children can be associated with hematuria and an increased risk of kidney stones.
- Hydrochlorothiazide (HCT) is a diuretic commonly used to manage hypercalciuria.
Purpose of the Study:
- To investigate the effects of hydrochlorothiazide on urinary calcium excretion in children with renal hypercalciuria.
- To assess the impact of hydrochlorothiazide treatment on serum cholesterol fractions in this pediatric population.
- To evaluate the potential atherogenic risks associated with long-term hydrochlorothiazide therapy.
Main Methods:
- A study involving 15 children diagnosed with renal hypercalciuria.
- Treatment with hydrochlorothiazide at a daily dose of 1 mg/kg for 3 months.
- Monitoring of urinary calcium excretion (calcium-to-creatinine ratio) and serum lipid profiles (total cholesterol, LDL, HDL) at baseline and during treatment.
Main Results:
- Hydrochlorothiazide significantly reduced urinary calcium excretion, with the lowest values observed after 2 weeks of treatment.
- A significant increase in total serum cholesterol and low-density lipoprotein (LDL)-cholesterol was noted after 3 months of treatment.
- High-density lipoprotein (HDL)-cholesterol showed a slight decrease, leading to a significant elevation in the atherogenic LDL/HDL ratio.
Conclusions:
- Hydrochlorothiazide is effective in reducing urinary calcium excretion in children with renal hypercalciuria.
- The observed increase in atherogenic cholesterol fractions suggests a potential cardiovascular risk with prolonged HCT use.
- A careful consideration of the risks versus benefits is crucial before initiating long-term hydrochlorothiazide therapy in children with hypercalciuria, hematuria, or kidney stone disease.
Abstract:
Urinary excretion of calcium and the changes in serum cholesterol fractions were investigated in 15 children with renal hypercalciuria, following 3-month hydrochlorothiazide (HCT) treatment (daily dose 1 mg/kg). Urinary calcium excretion (expressed as the ratio of calcium to creatinine) reached its lowest value after 2 weeks. It was still below the initial value at the end of the 3rd month of treatment (0.84 +/- 0.06, 0.29 +/- 0.03 and 0.6 +/- 0.09 mmol/mmol, respectively). A significant rise in the total serum cholesterol level (4.64 +/- 0.23 vs. 4.25 +/- 0.18 mmol/l before treatment, P < 0.01) and the low-density lipoprotein (LDL)-cholesterol fraction (2.6 +/- 0.24 vs. 2.31 +/- 0.31 before treatment, P < 0.01) was observed at the end of the 3rd month, while high-density lipoprotein (HDL)-cholesterol was slightly decreased. A significant elevation of the LDL/HDL ratio was also observed (from 1.76 +/- 0.17 to 2.2 +/- 0.17, P < 0.001), indicating an increase in the atherogenic cholesterol fractions. The risks and benefits of the thiazide therapy should be considered before starting long-term treatment of children with hypercalciuria and haematuria or renal stone disease.