Nephrocalcinosis and urolithiasis in children

Abstract

The incidence of adult urolithiasis has increased significantly in industrialized countries over the past decades. Sound incidence rates are not available for children, nor are they known for nephrocalcinosis, which can appear as a single entity or together with urolithiasis. In contrast to the adult kidney stone patient, where environmental factors are the main cause, genetic and/or metabolic disorders are the main reason for childhood nephrocalcinosis and urolithiasis. While hypercalciuria is considered to be the most frequent risk factor, several other metabolic disorders such as hypocitraturia or hyperoxaluria, as well as a variety of renal tubular diseases, e.g., Dent's disease or renal tubular acidosis, have to be ruled out by urine and/or blood analysis. Associated symptoms such as growth retardation, intestinal absorption, or bone demineralization should be evaluated for diagnostic and therapeutic purposes. Preterm infants are a special risk population with a high incidence of nephrocalcinosis arising from immature kidney, medication, and hypocitraturia. In children, concise evaluation will reveal an underlying pathomechanism in >75% of patients. Early treatment reducing urinary saturation of the soluble by increasing fluid intake and by providing crystallization inhibitors, as well as disease-specific medication, are mandatory to prevent recurrent kidney stones and/or progressive nephrocalcinosis, and consequently deterioration of renal function.

Pediatric idiopathic hypercalciuria with bilateral nephrolithiasis and hypertensive urgency

“…(6) PU affects children of all ages and seems to primarily appear in the first years of life, which might be due to the fact that it is frequently based on tubulopathies or inborn errors of metabolism. (7) The true burden in Indonesia is not known due to limited data; to date , here have been few case reports on this topic. The present case is important because there have been not many similar cases reported in Indonesia; this report is intended to be a trigger for doctors to increase their awareness and knowledge regarding the need of an appropriate search for the underlying metabolic abnormalities and their treatment in pediatric patients with urolithiasis.…”

4-Hydroxyglutamate Is a Biomarker for Primary Hyperoxaluria Type 3

“…Children, as compared to adults, are more likely to have an underlying metabolic derangement which results in a higher rate of stone recurrence. Urinary metabolic profiling is therefore recommended in all children with nephrolithiasis, as timely treatment may prevent stone formation (Habbig et al 2011). Primary hyperoxaluria type 3 (PH3, OMIM 613616) is a recently identified childhood oxalate kidney stone disease caused by mutations in the HOGA1 gene, formerly DHDPSL (Belostotsky et al 2010).…”

The Changing Epidemiology of Urolithiasis in Pediatric Patients

“…Others reduce the urinary concentration of solutes, such as citrate and magnesium that decrease stone formation [13]. Higher rates of hyperoxaluria, hyperuricosuria, hypercalciuria and hypocitraturia, and renal tubular acidosis have been identified in obese children with higher body fat content [14]. Nonetheless, a direct link between obesity and pediatric stone disease is yet to be established.…”