Bone Effects of Calcium Restriction Diet in Children with Absorptive Hypercalciuria

Perrone, Heloisa Cattini; Toporovski, Júlio; Bianco, A; Marone, Marília Martins Silveira; Langman, Craig B.; Schor, Nestor

doi:10.1007/978-1-4615-2556-1_248

Cited by 4 publications

(6 citation statements)

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“…In their initial series, Perrone et al [11] found osteopenia at lumbar spine sites in [11]. In a follow-up study with 46 patients, the same authors found significantly lower values of Z-BMD at lumbar spine and upper femur sites in patients with sustained hypercalciuria than in patients with controlled or intermittent hypercalciuria [24].…”

Section: Discussionmentioning

confidence: 95%

Bone mineral density in pediatric patients with idiopathic hypercalciuria

García‐Nieto

Ferrández

Monge

et al. 1997

Pediatric Nephrology

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It is well known that some patients with renal lithiasis due to idiopathic hypercalciuria (IH) may exhibit decreased bone mineral density (BMD). We have studied a large group of children with IH and related their BMD values to several renal function parameters and calcium and bone metabolism markers. Children with IH had higher osteocalcin and calcitriol levels and higher urinary excretion of magnesium and prostaglandin E2, as well as lower tubular reabsorption of phosphate, urinary excretion of ammonium, maximum urinary PCO2, and BMD compared with control group of children. In children with IH we observed a negative correlation between BMD and age. We found osteopenia in 22 of 73 children with IH (30.1%); these children showed lower citraturia levels and higher fractional excretion of uric acid than children with normal BMD. In osteopenic children there was a negative correlation between BMD and calcitriol levels. Several possible pathogenetic factors have been proposed for the bone mass loss. Our results demonstrate that, at least in some cases, it may be related to high levels of calcitriol, which has a wellknown resorption ability. Whether a certain degree of intracellular acidosis or a higher production of prostaglandin E2 could play a role in some cases is still an open question. In children with normal BMD we observed a direct correlation between osteocalcin and tartrate-resistant acid phosphatase levels; this correlation did not hold for children with osteopenia.

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Section: Discussionmentioning

confidence: 95%

Bone mineral density in pediatric patients with idiopathic hypercalciuria

García‐Nieto

Ferrández

Monge

et al. 1997

Pediatric Nephrology

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“…In 1992 Perrone et al [4] examined 20 children with IH resulting from increased intestinal absorption of calcium. At the time of diagnosis four children (20%) were found to have reduced BMD of the L2-L4 lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

Bone disease and hypercalciuria in children

Zerwekh

2009

Pediatr Nephrol

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There have been relatively few studies of bone mass in children with idiopathic hypercalciuria (IH). When performed, bone mineral density (BMD) measurements have consistently disclosed decreased Z-scores for children with IH at the lumbar spine and, to a lesser extent, at the femoral neck. Few investigations have delineated the nature of the mechanism(s) that may contribute to the bone loss in these children. Some studies have been consistent, showing increased bone resorption as the probable mechanism of bone loss. To date, there have been no reports regarding the assessment of biochemical markers specific for bone formation in children with IH. However, since most of the children with IH in these reports had demonstrated normal longitudinal growth, it seems less likely that there is an alteration in bone formation. The causes for increased bone resorption also are not firmly established, but genetics, dietary indiscretions, and altered cytokine production have been proposed as being contributory to the decreased BMD observed in these children with IH. Optimal bone mineral accretion during childhood and adolescence is important in attaining peak bone mass and may serve to prevent the development of osteoporosis in adulthood. Thus, a better understanding of bone loss in children with IH is warranted.

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“…Como citado, a HI pode acarretar redução da massa óssea tanto em crianças [40][41][42][43] como em adultos [10][11][12] . Infelizmente, no estudo, a avaliação óssea não foi realizada em todos os pacientes, o que impossibilitou a sua análise.…”

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Hipercalciúria idiopática: apresentação de 471 casos

Penido¹,

Diniz²,

Moreira³

et al. 2001

J. Pediatr. (Rio J.)

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Objective: to analyze the clinical history and evolution of children and adolescents with IH, emphasizing some of their peculiar features.Methods: we followed 471 patients with IH at an outpatient clinic. Patients were submitted to the following protocol: abdominal X-ray, kidney and urinary tract ultrasonography; urinary ionogram, blood gas and biochemical analyses; 24-hour urine for measurement of calcium and other electrolytes and creatinine; urinalysis, urine culture and phase-contrast microscopy; second morning urine collected after fasting for measurement of calcium and creatinine.Results: at the time of diagnosis, 6% of the patients were infants, 15% pre-school children, 55% school children, and 24% adolescents; 56% of them were boys. Clinical and laboratory findings were: 47% had hematuria and abdominal pain, 31% had isolated hematuria, 14% isolated abdominal pain, and 8% had urinary tract infection, nocturnal enuresis, suprapubic pain or urethralgia, or the frequency/urgency syndrome with urinary incontinence. Hypercalciuria was associated with urolithiasis in 56% of patients. There was association with hyperuricosuria in 18.5% of the cases, and hypocitraturia in 8.5% of the cases. Evolution was poor for 33% of the patients, with recurrence of nephrolithiasis, persistence of hematuria, and abdominal pain.Conclusions: IH must be diagnosed and treated with criteria in order to reduce consequences such as hematuria, abdominal pain, urinary stone formation and possible bone involvement. Signs and symptoms such as urgency and urinary incontinence, suprapubic pain and nocturnal enuresis may result from renal hyperexcretion of calcium.J Pediatr (Rio J) 2001; 77 (2): 101-4: hematuria, enuresis, urinary incontinence. ResumoObjetivo: analisar a história clínica e evolução de crianças e adolescentes com HI, ressaltando peculiaridades próprias destes pacientes.Métodos: 471 pacientes portadores de HI têm sido acompanhados em regime ambulatorial, sendo submetidos ao protocolo: Rx de abdome, ultra-sonografia de rins e vias urinárias; ionograma, gasometria e bioquímica de sangue; urina de 24 horas para dosagem de cálcio e outros eletrólitos e creatinina; urinálise, urocultura e microscopia de contraste de fase; urina de segunda micção matinal em jejum para dosagem de cálcio e creatinina.Resultados: 56% masculinos e 44% femininos; 56% brancos, 37% não-brancos e 7% sem relato da cor da pele. Ao diagnóstico 6% eram lactentes, 15% pré-escolares, 55% escolares e 24% adolescentes. 47% tinha hematúria associada à dor abdominal, 31% hematúria isolada, 14% dor abdominal isolada, e 8% tinham infecção urinária, enurese noturna, dor suprapúbica ou uretral ou a síndrome miccional com freqüência/urgência e incontinência urinária. A associação de hipercalciúria com litíase do trato urinário foi positiva em 56% dos pacientes. Em 18,5% houve associação com hiperuricosúria e em 8,5% com hipocitratúria. 33% dos pacientes tiveram má evolução com recorrência de nefrolitíase, persistência de hematúria e dor abdominal.Conclusões: a HI...

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Bone Effects of Calcium Restriction Diet in Children with Absorptive Hypercalciuria

Cited by 4 publications

References 4 publications

Bone mineral density in pediatric patients with idiopathic hypercalciuria

Bone mineral density in pediatric patients with idiopathic hypercalciuria

Bone disease and hypercalciuria in children

Hipercalciúria idiopática: apresentação de 471 casos

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