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Natural History of Hematuria Associated With Hypercalciuria in Children

Natural History of Hematuria Associated With Hypercalciuria in Children Abstract • Hypercalciuria (HCU) is frequently found during the evaluation of children with hematuria; the long-term implications of untreated HCU in children are uncertain. Since 1981, we have identified HCU (urinary calcium, >0.1 mmol ·kg−1·d−1) in 58 patients (41 male) with hematuria; 64% had gross hematuria and 74% had a relative with urolithiasis. Renal HCU was diagnosed in 19 patients and absorptive HCU in 24 patients. In 15 children, the calcium loading test was nondiagnostic. In nine patients (16%), urolithiasis developed, and in one patient, a renal calcification developed. These 10 patients (seven male) were older (10.1 vs 7.5 years) than the other 48 patients and initially presented with gross hematuria (nine of 10). All 10 patients had a family history of urolithiasis. The initial urinary calcium value was similar between the 10 patients with stones (0.15 mmol·kg−1·d−1) and the patients without stones (0.14 mmol·kg−1·d−1); five had absorptive HCU and four had renal HCU. At least one follow-up urinary calcium measurement was available for 23 patients who were not receiving thiazide therapy during 1 to 6 years after diagnosis (mean, 3.1 years). At 1-year follow-up, 12 of 17 patients had HCU and five had hematuria. Twenty-one patients were studied 2 to 3 years from diagnosis; 11 had HCU and eight had hematuria. After 4 years, six of seven patients had HCU and three had hematuria. We conclude that children with HCU and hematuria are at significant risk for urolithiasis, especially if they have gross hematuria and a family history of urolithiasis. Hypercalciuria may be episodic in children with hematuria, and factors other than urinary calcium concentration may be responsible for urinary bleeding. (AJDC. 1991;145:1204-1207) References 1. Moore ES, Coe FL, McMann BY, Favus MY. Idiopathic hypercalciuria in children: prevalence and metabolic characteristics . J Pediatr. 1978;92:906-910.Crossref 2. Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children . J Pediatr. 1981;99:716-719.Crossref 3. Roy S, Stapleton FB, Noe HN, Jerkins G. Hematuria preceding renal calculus formation in children with hypercalciuria . J Pediatr. 1981;99:712-715.Crossref 4. Stapleton FB, Roy S, Noe HN, Jerkins G. Hypercalciuria in children with hematuria . N Engl J Med. 1984;310:1345-1348.Crossref 5. Stapleton FB. Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children: the Southwest Pediatric Nephrology Study Group . Kidney Int. 1990;37:807-811.Crossref 6. Moore ES. Hypercalciuria in children . In: Berlyne GM, ed. Contributions to Nephrology . New York, NY: S Karger AG; 1981:20-32. 7. Ghazali S, Barratt TM. Urinary excretion of calcium and magnesium in children . Arch Dis Child. 1974;49:97-101.Crossref 8. Stapleton FB, Noe HN, Jerkins G, Roy S. Urinary excretion of calcium following an oral calcium loading test in healthy children . Pediatrics . 1982;69:594-597. 9. Stapleton FB, Noe HN, Jerkins G. Hypercalciuria in children with urolithiasis . AJDC . 1982;136:675-678. 10. Pak CYK, Britton F, Peterson R, et al. Ambulatory evaluation of nephrolithiasis: classification, clinical presentation and diagnostic criteria . Am J Med. 1980;69:19-28.Crossref 11. Stapleton FB, McKay CP, Noe HN. Urolithiasis in children: the role of hypercalciuria . Pediatr Ann . 1987; 16:980-992.Crossref 12. Walther PC, Lamm D, Kaplan GN. Pediatric urolithiasis: a 10-year review . Pediatrics . 1980;65:1068-1072. 13. Ghazali S, Barrett TM, Williams DI. Childhood urolithiasis in Britain . AJDC . 1973;48:291-295. 14. Choi H, Snyder HM, Duckett J. Urolithiasis in childhood: current management . J Pediatr Surg. 1987;22:158-164.Crossref 15. Pak CYK, Peters P, Hurt G, et al. Is selective therapy of recurrent nephrolithiasis possible? Am J Med. 1981;71:615-618.Crossref 16. Polinsky MS, Kaiser BA, Baluarte JH. Urolithiasis in children: the role of hypercalciuria . Pediatr Ann . 1987; 16:980-992.Crossref 17. Pak CYK. Medical management of nephrolithiasis in Dallas: update 1987 . J Urol . 1988;140:461-467. 18. Stapleton FB, Jones DP, Miller LA. Evaluation of bone metabolism in children with hypercalciuria . Semin Nephrol. 1989;9:75-79. 19. McMahon FG. Thiazides . In: McMahon GM, ed. Management of Essential Hypertension . New York, NY: Fuhre Publishing Co; 1978:21-54. 20. Churchill DN, Taylor DW. Thiazides for patients with recurrent calcium stones: still an open question . J Urol . 1985;133:749-751. 21. Stapleton FB. Nephrolithiasis in children . Pediatr Rev. 1989;11:21-30.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Natural History of Hematuria Associated With Hypercalciuria in Children

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References (24)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1991.02160100136039
Publisher site
See Article on Publisher Site

Abstract

Abstract • Hypercalciuria (HCU) is frequently found during the evaluation of children with hematuria; the long-term implications of untreated HCU in children are uncertain. Since 1981, we have identified HCU (urinary calcium, >0.1 mmol ·kg−1·d−1) in 58 patients (41 male) with hematuria; 64% had gross hematuria and 74% had a relative with urolithiasis. Renal HCU was diagnosed in 19 patients and absorptive HCU in 24 patients. In 15 children, the calcium loading test was nondiagnostic. In nine patients (16%), urolithiasis developed, and in one patient, a renal calcification developed. These 10 patients (seven male) were older (10.1 vs 7.5 years) than the other 48 patients and initially presented with gross hematuria (nine of 10). All 10 patients had a family history of urolithiasis. The initial urinary calcium value was similar between the 10 patients with stones (0.15 mmol·kg−1·d−1) and the patients without stones (0.14 mmol·kg−1·d−1); five had absorptive HCU and four had renal HCU. At least one follow-up urinary calcium measurement was available for 23 patients who were not receiving thiazide therapy during 1 to 6 years after diagnosis (mean, 3.1 years). At 1-year follow-up, 12 of 17 patients had HCU and five had hematuria. Twenty-one patients were studied 2 to 3 years from diagnosis; 11 had HCU and eight had hematuria. After 4 years, six of seven patients had HCU and three had hematuria. We conclude that children with HCU and hematuria are at significant risk for urolithiasis, especially if they have gross hematuria and a family history of urolithiasis. Hypercalciuria may be episodic in children with hematuria, and factors other than urinary calcium concentration may be responsible for urinary bleeding. (AJDC. 1991;145:1204-1207) References 1. Moore ES, Coe FL, McMann BY, Favus MY. Idiopathic hypercalciuria in children: prevalence and metabolic characteristics . J Pediatr. 1978;92:906-910.Crossref 2. Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children . J Pediatr. 1981;99:716-719.Crossref 3. Roy S, Stapleton FB, Noe HN, Jerkins G. Hematuria preceding renal calculus formation in children with hypercalciuria . J Pediatr. 1981;99:712-715.Crossref 4. Stapleton FB, Roy S, Noe HN, Jerkins G. Hypercalciuria in children with hematuria . N Engl J Med. 1984;310:1345-1348.Crossref 5. Stapleton FB. Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children: the Southwest Pediatric Nephrology Study Group . Kidney Int. 1990;37:807-811.Crossref 6. Moore ES. Hypercalciuria in children . In: Berlyne GM, ed. Contributions to Nephrology . New York, NY: S Karger AG; 1981:20-32. 7. Ghazali S, Barratt TM. Urinary excretion of calcium and magnesium in children . Arch Dis Child. 1974;49:97-101.Crossref 8. Stapleton FB, Noe HN, Jerkins G, Roy S. Urinary excretion of calcium following an oral calcium loading test in healthy children . Pediatrics . 1982;69:594-597. 9. Stapleton FB, Noe HN, Jerkins G. Hypercalciuria in children with urolithiasis . AJDC . 1982;136:675-678. 10. Pak CYK, Britton F, Peterson R, et al. Ambulatory evaluation of nephrolithiasis: classification, clinical presentation and diagnostic criteria . Am J Med. 1980;69:19-28.Crossref 11. Stapleton FB, McKay CP, Noe HN. Urolithiasis in children: the role of hypercalciuria . Pediatr Ann . 1987; 16:980-992.Crossref 12. Walther PC, Lamm D, Kaplan GN. Pediatric urolithiasis: a 10-year review . Pediatrics . 1980;65:1068-1072. 13. Ghazali S, Barrett TM, Williams DI. Childhood urolithiasis in Britain . AJDC . 1973;48:291-295. 14. Choi H, Snyder HM, Duckett J. Urolithiasis in childhood: current management . J Pediatr Surg. 1987;22:158-164.Crossref 15. Pak CYK, Peters P, Hurt G, et al. Is selective therapy of recurrent nephrolithiasis possible? Am J Med. 1981;71:615-618.Crossref 16. Polinsky MS, Kaiser BA, Baluarte JH. Urolithiasis in children: the role of hypercalciuria . Pediatr Ann . 1987; 16:980-992.Crossref 17. Pak CYK. Medical management of nephrolithiasis in Dallas: update 1987 . J Urol . 1988;140:461-467. 18. Stapleton FB, Jones DP, Miller LA. Evaluation of bone metabolism in children with hypercalciuria . Semin Nephrol. 1989;9:75-79. 19. McMahon FG. Thiazides . In: McMahon GM, ed. Management of Essential Hypertension . New York, NY: Fuhre Publishing Co; 1978:21-54. 20. Churchill DN, Taylor DW. Thiazides for patients with recurrent calcium stones: still an open question . J Urol . 1985;133:749-751. 21. Stapleton FB. Nephrolithiasis in children . Pediatr Rev. 1989;11:21-30.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Oct 1, 1991

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