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Hypercalciuria and nephrocalcinosis in children
M M Moxey-Mims1, F B Stapleton
1State University of New York, Buffalo.
Insights
Hypercalciuria, or high urinary calcium, is common in children with kidney issues. Its long-term effects and optimal treatment remain unclear, but it may lead to nephrocalcinosis.
Area of Science:
- Pediatric Nephrology
- Clinical Urology
Background:
- Hypercalciuria is a frequent finding in pediatric patients with nonglomerular hematuria and nephrolithiasis.
- The long-term consequences of hypercalciuria in children are not well understood.
- Therapeutic interventions for pediatric hypercalciuria are debated.
Purpose of the Study:
- To review the current understanding of hypercalciuria in children.
- To discuss the association between hypercalciuria and nephrocalcinosis.
- To explore emerging insights into the pathogenesis and treatment of nephrocalcinosis.
Main Methods:
- Literature review of pediatric hypercalciuria and nephrocalcinosis.
- Analysis of current diagnostic and therapeutic approaches.
- Discussion of recent advancements in understanding crystal inhibitors.
Main Results:
- Hypercalciuria is the most common abnormality in children with hematuria and kidney stones.
- Nephrocalcinosis is increasingly detected with advanced imaging, prompting reevaluation of therapies.
- New urinary crystal inhibitors have been identified.
Conclusions:
- Understanding the pathogenesis of nephrocalcinosis is crucial for developing targeted therapies.
- Further research is needed to clarify the long-term implications of hypercalciuria in children.
- Personalized therapeutic strategies for hypercalciuria and nephrocalcinosis are anticipated.
Abstract:
Hypercalciuria has become a significant clinical focus both for pediatricians and for pediatric nephrologists after it was found that increased urinary calcium excretion is the most common abnormality in children with nonglomerular hematuria and with nephrolithiasis. The question of long-term implications of hypercalciuria in growing children, regardless of the underlying cause, remains unanswered. Whether dietary or pharmacologic therapy is warranted in children with hypercalciuria is controversial. One of the proposed consequences of hypercalciuria is nephrocalcinosis. With the availability of increasingly sensitive, noninvasive imaging techniques, nephrocalcinosis is being recognized more frequently. In some instances, concern about the risk and progression of nephrocalcinosis is provoking reevaluation of well-established metabolic therapies. New urinary inhibitors of crystal formation and aggregation have recently been identified. As the basic pathogenesis of nephrocalcinosis becomes clearer, clinical therapies will become more specific and effective.