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Hematuria due to hyperuricosuria in children: 36-month follow-up
H Cattini Perrone1, F Bruder Stapleton, J Toporovski
1Nephrology Division, Escola Paulista de Medicina, São Paulo, Brazil.
Insights
Hyperuricosuria (HU), characterized by high urinary acid excretion, is linked to recurrent childhood hematuria. Early identification of HU can prevent invasive diagnostic procedures and guide appropriate management.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Hyperuricosuria (HU) is a significant risk factor for kidney stone formation.
- HU accounts for 5-20% of recurrent hematuria cases in children.
- The association between isolated hematuria and HU requires further investigation.
Purpose of the Study:
- To prospectively evaluate the link between isolated hematuria and hyperuricosuria in children.
- To assess the incidence of idiopathic hypercalciuria (IH) in patients with HU.
- To determine the natural history and potential complications of HU in pediatric patients.
Main Methods:
- Prospective study of 30 children (3-13 years) with isolated hematuria and HU.
- Duration of follow-up: 6 to 36 months.
- Assessment of family history of nephrolithiasis and development of idiopathic hypercalciuria.
Main Results:
- 40% of patients had a positive family history of nephrolithiasis.
- Idiopathic hypercalciuria (IH) was diagnosed in 20% of patients after 6-24 months.
- Untreated patients showed a 13% incidence of urolithiasis at 6 months and 6% at 12 months.
- Therapeutic interventions normalized uricosuria and resolved hematuria in 6-12 months.
Conclusions:
- Hyperuricosuria is associated with hematuria in children, similar to idiopathic hypercalciuria.
- Recognizing HU as a cause of hematuria can avert unnecessary invasive diagnostic tests.
- Management of HU may prevent the development of urolithiasis in affected children.
Abstract:
Hyperuricosuria (HU), defined as a urinary acid excretion higher than 95 percent of normal values, is an important lithogenic factor, accounting for about 5-20% of recurrent hematuria in childhood. We prospectively studied 30 children (15 male, 15 female; aged 3 to 13 years old) with previously undiagnosed isolated hematuria and HU for 6 to 36 months. The family history of nephrolithiasis was positive in 40%. Idiopathic hypercalciuria (IH), UCa > 4 mg/kg/day, was not found initially, but was diagnosed after 6 to 24 months in 20% of the patients. The following treatments were utilized: restricted purine diet (13%), allopurinol (4%) and potassium citrate (1%). No specific treatment was given to 82% of the patients. Therapy normalized uricosuria with resolution of hematuria over 6-12 months. Thirteen percent and 6% of untreated patients developed urolithiasis after 6 and 12 months respectively. The data suggest that HU, like IH, is associated with hematuria. Furthermore, recognition of this association may prevent unnecessary, and in some cases, invasive diagnostic manoeuvres.