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[Idiopathic hypercalciuria: clinical manifestation, outcome and risk for urolithiasis in children]
J Escribano Subias1, M Vicente Rodríguez, A Feliu Rovira
1Servicio de Pediatría, Hospital Universitario St. Joan Reus, Tarragona.
Insights
Children with untreated idiopathic hypercalciuria (IH) are at increased risk for developing urolithiasis, especially if diagnosed later in childhood or presenting with lumbar pain.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Bone Disease
Background:
- Idiopathic hypercalciuria (IH) is a common metabolic disorder in children.
- Untreated IH can lead to urolithiasis, necessitating investigation into its clinical course and risk factors.
Purpose of the Study:
- To investigate the clinical manifestations, outcomes, and risk factors for urolithiasis in children with untreated idiopathic hypercalciuria (IH).
Main Methods:
- A 5-year study included children with IH (urinary calcium > 4 mg/kg/day) presenting with hematuria, lower urinary tract symptoms (LUS), or abdominal pain.
- Analysis correlated age, gender, IH subtype, and clinical features with urolithiasis development.
Main Results:
- Of 76 children with IH, 18 (23%) developed urolithiasis.
- Older age at diagnosis (>9 years) and initial presentation with lumbar pain were significant risk factors for urolithiasis.
- Clinical presentation varied with age, with LUS more common in younger children and flank pain in older ones.
Conclusions:
- An age-dependent clinical pattern exists for pediatric IH.
- Delayed diagnosis (>9 years) and lumbar pain at presentation significantly increase urolithiasis risk in children with IH.
Objective:
The purpose of this study was to investigate the clinical manifestations, outcome and risk factors for urolithiasis of untreated idiopathic hypercalciuria (IH) in children.
Patients And Methods:
During a 5 year period, all children with hematuria, lower urinary tract symptoms (LUS), or abdominal pain who were observed to have IH (urinary calcium > 4 mg/kg/day) were included in the study. The relationship between some variables (age, gender, hypercalciuria subtype, and clinical features) and urolithisis was analyzed.
Results:
We studied 76 children with IH (9 with renal IH, 49 with absorptive IH and 18 with undetermined IH). Hematuria (46%), LUS (27.6%), lumbar pain (22%) and abdominal pain (15.7%) were the most common initial symptoms. We found a significant difference between age and clinical presentation. LUS were found more frequently in young children (46.4%) and flank pain in older patients (47.8%). Hematuria was age dependent. Eighteen (23%) patients developed urolithiasis. These 18 patients tended to be older (9.3 vs 6 years) than the other 58 children. Age at diagnosis presented a linear relationship with the development of urolithiasis (p < 0.001). Significant relative risk for urolithiasis (4.3) was found in those children who initially presented with lumbar pain. In all other parameters measured (calciuria, uricosuria, oxaluria, citraturia) and clinical characteristics analyzed, there were no statistically significant differences between those with and without stones.
Conclusions:
An age-dependent clinical pattern can be established for children with hypercalciuria. Significant risk for urolithiasis accompanies those children who are diagnosed later (> 9 years) and who initially present with lumbar pain.