Should pediatric idiopathic hypercalciuria be treated with hypocalciuric agents?

Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares
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引用次数: 3

Abstract

Background: Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients. Reduced bone mineral density (BMD) was already described in idiopathic hypercalciuria (IH) children, but the precise mechanisms of bone loss or inadequate bone mass gain remain unknown. Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life. The peak of bone mass should occur without interferences. A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown.

Aim: To evaluate whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH.

Methods: This retrospective cohort study evaluated 40 hypercalciuric children non-responsive to lifestyle and diet changes. After a 2-mo run-in period of citrate formulation (Kcitrate) usage, the first bone densitometry (DXA) was ordered. In patients with sustained hypercalciuria, a thiazide diuretic was prescribed. The second DXA was performed after 12 mo. Bone densitometry was performed by DXA at lumbar spine (L2-L4). A 24-h urine (calcium, citrate, creatinine) and blood samples (urea, creatinine, uric acid, calcium, phosphorus, magnesium, chloride, hemoglobin) were obtained. Clinical data included age, gender, weight, height and body mass index.

Results: Forty IH children; median age 10.5 year and median time follow-up 6.0 year were evaluated. Nine patients were treated with Kcitrate (G1) and 31 with Kcitrate + thiazide (G2). There were no differences in age, gender, body mass index z-score and biochemical parameters between G1 and G2. There were no increases in total cholesterol, kalemia and magnesemia. Calciuria decreased in both groups after treatment. Lumbar spine BMD z-score increased after thiazide treatment in G2. There was no improvement in G1.

Conclusion: Results point to a beneficial effect of thiazide on lumbar spine BMD z-score in children with IH. Further studies are necessary to confirm the results of the present study.

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儿童特发性高钙尿应该用低钙药治疗吗?
背景:高钙尿是钙性尿石症最常见的代谢危险因素,与成人患者骨质流失有关。特发性高钙尿症(IH)儿童的骨密度(BMD)降低已被描述,但骨质流失或骨量增加不足的确切机制尚不清楚。终身高钙尿症可能被认为是改变骨结构的风险,并在一生中决定低骨量。骨量的峰值应该在没有干扰的情况下出现。柠檬酸盐制剂和噻嗪类药物对成人和儿童IH患者骨量的有益影响已被证实。目的:评价药物治疗对儿童和青少年IH患者骨量的有益影响。方法:本回顾性队列研究评估了40名对生活方式和饮食改变无反应的高钙血症儿童。经过2个月的柠檬酸盐配方(Kcitrate)使用磨合期后,进行第一次骨密度测定(DXA)。对于持续性高钙尿症患者,开噻嗪类利尿剂。12个月后进行第二次DXA。腰椎(L2-L4)进行DXA骨密度测定。取24小时尿液(钙、柠檬酸、肌酐)和血液样本(尿素、肌酐、尿酸、钙、磷、镁、氯化物、血红蛋白)。临床资料包括年龄、性别、体重、身高和身体质量指数。结果:40例IH患儿;中位年龄10.5岁,中位随访时间6.0年。k柠檬酸盐组9例(G1), k柠檬酸盐+噻嗪类药物组31例(G2)。G1与G2在年龄、性别、体质指数z-score及生化指标上均无差异。总胆固醇、钾血症和镁血症没有增加。治疗后两组患者的钙尿量均有所下降。噻嗪类药物治疗后,G2组腰椎BMD z评分升高。G1期无明显改善。结论:结果表明噻嗪类药物对IH患儿腰椎BMD z-score有有益作用。需要进一步的研究来证实本研究的结果。
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