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Renal acidification in children with idiopathic hypercalciuria
M Bonilla-Felix1, O Villegas-Medina, V M Vehaskari
1Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
The Journal of Pediatrics
|April 1, 1994
Summary
Children with hypercalciuria (high urine calcium) rarely have distal renal tubular acidosis unless they also have kidney stones. Kidney stones may cause tubular damage leading to this condition.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Physiology
Background:
- Distal renal tubular acidosis (dRTA) is often linked to hypercalciuria.
- The causal relationship between these conditions requires further investigation.
Purpose of the Study:
- To assess for evidence of dRTA in children with idiopathic hypercalciuria.
- To explore the association between hypercalciuria, dRTA, and nephrolithiasis in pediatric patients.
Main Methods:
- Evaluated 20 children (5-18 years) with idiopathic hypercalciuria.
- Utilized furosemide challenge and acetazolamide loading tests to assess urinary acidification.
- Administered arginine hydrochloride for acute acid loading in suspicious cases.
- Compared prevalence of dRTA in children with and without nephrolithiasis.
Main Results:
- One child showed a potential acidification defect post-furosemide.
- Three children exhibited findings consistent with rate-dependent dRTA after acetazolamide.
- All four children with suspected dRTA failed to excrete adequate ammonium during acid loading.
- Four of six patients with nephrolithiasis had dRTA, versus none of 14 without stones (p=0.003).
Conclusions:
- Distal acidification appears intact in children with hypercalciuria but no kidney stones.
- Nephrolithiasis may be a contributing factor to tubular damage, potentially causing dRTA in hypercalciuric children.
- Further research is warranted to understand the link between calcium precipitation and tubular dysfunction.