Inhibitors of Stone Formation in Hypercalciuric Children with and without Stone Disease

Al-Qadreh, A.; Athanasopoulou, Helen; Voskaki, I

doi:10.1159/000474843

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…In contrast, in our study U Ca/Cit ratio was not influenced by either age or gender in children when analyzed with and without adjustment for these factors (Table 1). Gender by itself had no influence on either urinary calcium/creatinine, citrate/creatinine, or calcium/ citrate ratios as was found in other pediatric studies (17,21,28). Indeed, in contrast to the adult population, the absence of preponderance of urolithiasis in boys in our study and others indirectly further supports the lack of gender influence in the pediatric population (29,30).…”

Section: Discussionsupporting

confidence: 71%

“…However, it was the impression in the above studies that the clinical use of urine calcium/citrate ratio was limited because of its wide range of variability and the influence of age and gender on urinary excretion of citrate. There is limited data on urine calcium/ citrate ratio in either healthy, hypercalciuric, or stone forming children (17,18). Treatment of stone formers with citrate raises the theoretical concern of increased formation of calcium phosphate crystals in alkaline urine.…”

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confidence: 99%

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Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

et al. 2009

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Hypercalciuria is a common cause for stone formation in children. The aim was to delineate the role of urinary citrate in hypercalciuric children for protection against calcium stone formation. We evaluated random urine calcium, citrate, and creatinine in 149 controls, 78 hypercalciuric nonstone formers, and 34 hypercalciuric children with stone. Urine citrate/creatinine was highest in hypercalciuric nonstone formers 899 Ϯ 351 compared with controls 711 Ϯ 328 and stone formers 595 Ϯ 289 (p Ͻ 0.01 vs. both). Calcium/creatinine ratio was similar in hypercalciuric stone and nonstone formers, but significantly higher than controls. Consequently, urine Calcium/citrate ratio (mg/mg) increased from control 0.17 Ϯ 0.17 to 0.41 Ϯ 0.23 (p Ͻ 0.001) in hypercalciuric nonstone formers, and to 0.65 Ϯ 0.46 in stone formers (p Ͻ 0.001 compared with other groups). Area under receiver operating characteristic curve combined with multilevel risk analyses found calcium/citrate ratio of 0.326 to provide good discrimination between control and stone formers. We found 5th percentile for random urine citrate/creatinine ratio in school-aged children to be 176 mg/g, elevated urinary citrate excretion in hypercalciuric children to be protective against stone formation, and urine calcium/citrate ratio to be a good indicator for risk of stone formation. Whether intervention in hypercalciuric children to lower urine calcium/citrate Ͻ0.326 will provide protection against stone formation needs to be studied. (Pediatr Res 66: 85-90, 2009) T he incidence of urolithiasis in children has increased in recent years (1). The risk factors for urolithiasis commonly observed in children are low urine volume, increased urine calcium excretion, and low normal or decreased urinary citrate level (2). Citrate inhibits the spontaneous nucleation of calcium oxalate, crystal growth of calcium oxalate and calcium phosphate, and the heterogeneous nucleation of calcium oxalate by monosodium urate (3-8). Bisaz et al. (9) reported that citrate is responsible for 50% of the inhibitory activity against calcium phosphate precipitation in normal urine. The inhibitory effect of citrate on calcium oxalate crystal growth and aggregation is also linked to a direct effect on the crystal surface (3,10). Consequently, and because of lack of significant adverse effects, citrate preparations are widely used in subjects with calcium oxalate nephrolithiasis (2,11-13).In adult studies, Welshman and McGeown (14), Hobarth and Hofbauer (15) and Nikkila et al. (16) observed that urine calcium/citrate ratio was able to discriminate between stone formers and control population; the latter exhibiting a significantly lower calcium/citrate ratio. However, it was the impression in the above studies that the clinical use of urine calcium/citrate ratio was limited because of its wide range of variability and the influence of age and gender on urinary excretion of citrate. There is limited data on urine calcium/ citrate ratio in either healthy, hypercalciuric, or stone forming child...

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Section: Discussionsupporting

confidence: 71%

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confidence: 99%

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

et al. 2009

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“…17 In vitro studies of crystal growth show that magnesium is an inhibitor of crystal growth, and that administration of oral magnesium to stone formers causes a reduction in urine saturation index. 18 Reduced magnesium intake has been associated with hyperreactivity of the airways, and thus may be associated with the etiology of asthma. 19 Other conditions, including chronic fatigue syndrome, sudden death in athletes, and increased susceptibility to infections and migraines, have all been linked to low serum magnesium.…”

Section: Magnesium Disordersmentioning

confidence: 99%

Magnesium Disorders

Mascarenhas

Vashistha

Kumbala

2015

Hospital Medicine Clinics

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“…Several studies demonstrate hypercalciuria, hypocitraturia, hyperoxaluria and hyperuricosuria in preterm neonates with NC [13,[20][21][22]. Various factors contribute to these urinary findings, including immaturity of renal function, metabolic acidosis, dietary intake and presence and treatment of chronic lung disease with diuretic therapy, such as furosemide, and corticosteroids [1,13,23].…”

Section: Introductionmentioning

confidence: 99%

Does citrate prevent nephrocalcinosis in preterm neonates?

et al. 2006

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Nephrocalcinosis (NC) occurs frequently in preterm neonates. A high U-calcium/citrate is one of the contributing factors to the development of NC. In stone-forming children and adults citrate supplementation is a successful preventive therapy. In this randomized controlled trial the effect of citrate therapy was studied on the development of NC in preterm neonates with a gestational age <32 weeks. Thirty-eight preterm neonates (mean gestational age 29.8 weeks (SD 1.6), mean birth weight 1,300 g (SD 351) were treated with sodium citrate (0.52 mmol/kg/day in four doses) from day 8 of life until at term and 36 preterm neonates (mean gestational age 29.6 weeks (SD 1.6), mean birth weight 1,282 g (SD 256) were not treated. U-calcium, U-creatinine, U-citrate and U-pH were measured at day 7, 14, 21, 28 of life and at term. Renal ultrasonography (US) was performed at term. U-citrate/creatinine and U-pH were significantly higher and U-calcium/citrate was significantly lower in the citrate group at day 14, 21 and 28 compared with the control group (P<0.05). Complications of citrate administration were not encountered, however the incidence of NC was not significantly different in the treated (34%) compared with the control group (44%), P=0.37. Preterm neonates treated with citrate in the first months of life have higher U-citrate/creatinine and lower U-calcium/citrate compared with controls. Sodium citrate therapy in a dosage of 0.52 mmol/kg/day is safe but does not prevent NC. Whether a higher dose or potassium citrate decreases the incidence of NC should be evaluated in further studies.

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Inhibitors of Stone Formation in Hypercalciuric Children with and without Stone Disease

Cited by 3 publications

References 19 publications

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

Magnesium Disorders

Does citrate prevent nephrocalcinosis in preterm neonates?

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