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Published on: June 27, 2015
[Hypercalciuria: etiologies and treatment]
1Service de pédiatrie I, hôpital Arnaud-de-Villeneuve, Montpellier, France.
Insights
Hypercalciuria, or high urinary calcium, is a rare condition in children, often idiopathic and potentially hereditary. Management includes hydration and, in some cases, hydrochlorothiazide, though long-term effects require consideration.
Area of Science:
- Pediatric Nephrology
- Clinical Biochemistry
Context:
- Hypercalciuria is a rare pediatric condition with diverse causes.
- Established normal urinary calcium excretion rates and calcium:creatinine ratios differ between children and infants.
- Idiopathic hypercalciuria accounts for approximately half of pediatric cases and can be hereditary.
Purpose:
- To define hypercalciuria in children and infants.
- To explore the potential etiologies and pathophysiology of idiopathic hypercalciuria.
- To discuss management strategies and associated risks.
Summary:
- Hypercalciuria is characterized by elevated urinary calcium excretion, with specific thresholds for children and infants.
- Idiopathic hypercalciuria, potentially hereditary, involves increased intestinal calcium absorption or reduced renal tubular reabsorption.
- High fluid intake is recommended for prevention of urolithiasis; hydrochlorothiazide may be used for recurrent lithiasis or nephrocalcinosis, despite potential adverse effects.
Impact:
- Informs diagnosis and management of pediatric hypercalciuria.
- Highlights the hereditary nature and unclear pathophysiology of idiopathic hypercalciuria.
- Raises awareness regarding hydrochlorothiazide's long-term implications and the importance of hydration.
Abstract:
Hypercalciuria is a rare biological symptom with multiple possible etiologies in children. Normal calcium excretion rate in children is defined as lower than 4 mg/kg per day, significantly higher values being observed in infants. When using urinary calcium: creatinine ratio, normal values are below 0.22 mg/mg in children, and below 0.6 to 0.8 mg/mg in infants. In our experience half patients with hypercalciuria have idiopathic hypercalciuria. Idiopathic hypercalciuria can be hereditary with a dominant autosomal mode of inheritance. Its pathophysiology is unclear, increased calcium intestinal absorption and impaired renal tubular calcium reabsorption being the two main underlying anomalies. Patients with hypercalciuria should be informed about the risk of urolithiasis and its possible prevention by a high water intake. In those patients with nephrocalcinosis or recurrent episodes of lithiasis, hydrochlorothiazide can be effective in reducing hypercalciuria. However, adverse effects of hydrochlorothiazide on serum lipids have been recently reported and make this treatment questionable in the long term.
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