Idiopathic hypercalciuria: presentation of 471 cases

Abstract

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...

The Association between Urinary Tract Infection and Idiopathic Hypercalciuria in Children

“…Moreover, renal calyceal microlithiasis or nephrolithiasis develops in some of these patients during the long-term follow-up. 8 In recent studies, remarkable improvement has been observed in the majority of these clinical conditions with the treatment of IHC. [8][9][10][11][12][13][14][15][16] Since many of these conditions including UTI may also lead to significant morbidity and mortality in children, identification of IHC is of great importance.…”

“…Hematuria, which can also occur in the absence of urolithiasis, is also an important clinical symptom in the subjects with IHC and has been reported to be 21%-50.3%. 8,10,11,32 Stojanovic et al 6 reported that, 6.7% of the 75 subjects with UTI had microscopic hematuria, and all of them had IHC. In a study performed by Lopez et al, 18 the frequency of hematuria was reported to be 12% in patients with recurrent UTI and IHC.…”

Monosemptomatik Enürezis Noktürnalı Çocuklarda Hiperkalsiüri

“…Normal popülasyonda hiperkalsiüri sıklığının %3-%7 arasında olduğu bildirilmiştir (11,12). Çalışmamızda gece altını ıslatmayan sağlıklı çocuklarımızdan sadece birisinde (%3) hiperkalsiüri belirledik.…”

“…Çalışmamızda hiperkalsiüri alt tipinin belirlenmesi için özel bir çaba harcanmadı. Klasik olarak hiperkalsiüri, absorbtif, rezorbtif ve renal olarak üç alt grupta incelenir (2,11). Hiperkalisürili hastalarımızın serum kalsiyum, fosfor, sodyum, potasyum ve parathormon düzeylerinin normal olması nedeniyle absorbtif ve rezorbtif hiperkalsiüri tipleri dışlandı.…”

Treatment of idiopathic hypercalciuria and its impact on associated diseases

“…4 Yet, there is consensus regarding the implementation of a sequential therapy when IH is associated with the development of urinary tract infections, dysfunctional micturition, nephrolithiasis, nephrocalcinosis, and osteopenia. 1,2,5 The objectives of this article were: 1. To describe hypercalciuria response to sequential therapy.…”