Professional Documents
Culture Documents
Urinary Calcium and Uric Acid Excretion in Children With Vesicoureteral Reflux
Urinary Calcium and Uric Acid Excretion in Children With Vesicoureteral Reflux
DOI 10.1007/s00467-011-1936-4
ORIGINAL ARTICLE
Received: 7 October 2010 / Revised: 22 May 2011 / Accepted: 24 May 2011 / Published online: 4 August 2011
# IPNA 2011
Introduction
Urinary calculi in children is a relatively common entity for
which an annual incidence of about 1% have been observed
in some countries [1]. The many factors contributing to
stone formation fall into two broad categories, namely,
anatomical abnormalities and metabolic disorders [25].
Anatomical abnormalities, such as ureteropelvic junction
obstruction (UPJO) or vesicoureteral reflux (VUR) are
associated with infection and urinary stasis, both of which
enhance stone formation [3, 6]. The traditional view of
96
Results
The VUR group consisted of 108 children with VUR (19
boys, 89 girls) and the control group comprised 110 healthy
children (30 boys, 80 girls). The mean age of patients in the
VUR group was 29.6929.27 months and that of the children
in the control group was 59.3635.71 months. Demographic
data for both groups are presented in Table 1. There were 23
children (21.3%) in the VUR group and four children (3.6%)
in the control group with hypercalciuria, [odds ratio (OR)
7.17, 95% confidence interval (CI) 2.3821.53, P=0.0001).
We also identified 20 children (18.5%) in the VUR group and
two children (1.8%) in the control group with hyperuricosuria (OR12.27, 95% CI 2.7953.94, P=0.0001) (Table 1).
The mean Ca/Cr and mean UA/Cr ratios differed
significantly between the two study groups (case vs.
97
Table 1 Demographic data on the two study groups in relation to hypercalciuria and hyperuricosuria
Demographic data
Case
Control
Pa
Number of patients
Age, years (meanSD)
Sex (male:female)
Hypercalciuria
Hyperuricosuria
108
29.6929.27
19 (17.6%):89 (82.4 %)
23 (21.3%)
20 (18.5%)
110
59.3635.71
30 (27.3%):80 (72.7%)
4 (3.6 %)
2 (1.8 %)
<0.001b
0.08
<0.0001
<0.0001
t test
t test
Discussion
Our results demonstrate that among the children participating in this study, the frequency of hypercalciuria was
Group
Mean
SD
Median
Range
Pa
Ca/Cr (mg/mg)
Control
Case
Control
Case
110
108
110
108
0.1808
0.3102
0.3500
0.5167
0.09689
0.22155
0.14822
0.46991
0.15
0.18
0.33
0.30
0.110.60
0.111.08
0.121.30
0.191.96
<0.0001
UA/Cr (mg/mg)
<0.0001
98
Table 3 Association of hypercalciuria, hyperuricosuria and
Ca/Cr with VUR grading
Chi-square test
MannWhitney U test
VUR
Positive
Negative
Pa
Hypercalciuria
Mild
Moderate
Severe
Mild
Moderate
Severe
Mild
Moderate
Severe
9 (14.3%)
9 (22.5%)
7 (24.1%)
10 (15.9%)
8 (20.0%)
7 (24.1%)
0.18 (0.110.96)
0.27 (0.120.90)
0.15 (0.110.90)
54 (85.7%)
31( 77.5%)
22 (75.9%)
53 (84.1%)
32 (80.0%)
22 (75.9%)
0.30 (0.121.08 )
0.18 (0.111.08)
0.19 (0.111.08)
0.03
0.8
0.6
0.4
0.7
0.3
0.1b
0.3b
0.3b
Hyperuricosuria
Ca/Cr
References
1. Kroovand RL (1997) Pediatric urolithiasis. Urol Clin North Am
24:173184
2. Mathew R, Matto TK (2008) Vesicoureteral Reflux. In: Geary DF,
Schaefer F (eds) Comprehensive pediatric nephrology, 1st edn.
Mosby Elsevier, Philadelphia, pp 499525
3. Naseri M, Varasteh AR, Alamdaran SA (2010) Metabolic factors
associated with urinary calculi in children. Iran J Kidney Dis
4:3238
4. Kheradpir MH, Bodaghi E (1990) Childhood urolithiasis in Iran
with special reference to staghorn calculi. Urol Int 45:99103
5. Fallahzadeh MK, Fallahzadeh MH, Mowla A, Derakhshan A
(2010) Hypercalciuria in children with urinary tract symptoms.
Saudi J Kidney Dis Transpl 21:673677
6. Garcia-Nieto V, Navarro JF, Luis-Yanes MI, Lopez-Mendes M,
Garcia-rodriguez V (2007) Hypercalciuria in pediatric patients
with ureteropelvic junction obstruction is of genetic origin. Scand
J Urol Nephrol 41:144148
7. Rodriguez A, Calahora FJ, Castro M, Andres A, Montoyo C,
Praga M (1990) Hypercalciuria and hyperuricosuria causing
hematuria in the absence of nephrolithiasis. Actas Urol Esp
14:188191
8. Levy FL, Kemp RD, Breyer JA (1994) Macroscopic hematuria
secondary to hypercalciuria and hyperuricosuria. Am J Kidney
Dis 24:515518
9. Penido MG, Diniz JS, Guimeraes MM, Cardoso RB, Souto MF,
Penido MG (2002) Urinary excretion of calcium, uric acid, and citrate
in healthy children and adolescents. J Pediatr (Rio J) 78:153160
99
26. Milliner DS (2004) Urolithiasis. In: Avner ED, Harmon WE,
Niaudet P (eds) Pediatric nephrology. Lippincott, Williams and
Wilkins, New York, pp 10911111
27. Moxey-Mims M (2007) Hematuria and proteinuria. In: Kher K,
Schnaper HW, Makker SP (eds) Clinical pediatric nephrology, 2nd
edn. Informa UK, London, pp 129141
28. Jantausch B, Kher K (2007) Urinary tract infection. In: Kher K,
Schnaper HW, Makker SP (eds) Clinical pediatric nephrology, 2nd
edn. Informa UK, London, pp 553573
29. Khoury A, B gli DJ (2007) "Reflux and megaureter" In: Wein AJ,
Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) CampbellWalsh urology, 9th edn. Saunders Elsevier, Philadelphia, pp 34233481
30. Kruse K, Kracht U, Kruse U (1984) Reference values for urinary
calcium excretion and screening for hypercalciuria in children and
adolescents. Eur J Pediatr 143:2531
31. Domino FJ (2010) Nephropathy urate. In: Domino FJ (ed) The 5minute clinical consult 2011, 19th edn. Lippincott, Williams and
Wilkins, Philadelphia, pp 884-886.
32. Poyrazoglu HM, Dusunsel R, Yazici C, Durmaz H, Dursun I, Sahin
H, Gunduz Z, Gurgoze MK (2009) Urinary uric acid/creatinine
ratios in healthy Turkish children. Pediatr Int 51:526529
33. Alon US, Srivastava T (2007) Urolithiasis. In: Kher K, Schnaper
HW, Makker SP (eds) Clinical pediatric nephrology, 2nd edn.
Informa UK, London, pp 539551
34. Hoppe B, Leumann E, Milliner DS (2008) Urolithiasis and
nephrocalcinosis in childhood. In: Geary DF, Schaefer F (eds)
Comprehensive pediatric nephrology, 1st edn. Mosby Elsevier,
Philadelphia, pp 499525
35. Giugliani R, Dutra-Filho CS, Pereira ML, Enk V (1985) Use of
the Urine uric acid to creatinine ratio for the detection of disorders
of purine metabolism: normal values among 0 to 12 years old
children. Braz J Genet 3:421425
36. Ahmadzadeh A, Hakimzadeh M, Safa-Abadi A (2008) Idiopathic
hypercalciuria in Iranian children. Iran J Pediatr 18:163166
37. Matos V, Van Melle G, Werner D, Bardy D, Guignard JP (1999)
Urinary oxalate and urate to creatinine ratios in a healthy pediatric
population. Am J Kidney Dis 34:E6
38. Esfahani ST, Madani A, Siadati AA, Nabavi M (2007) Prevalence
and symptoms of idiopathic hypercalciuria in primary school
children of Tehran. Iran J Pediatr 17:353358
39. Kheradpir MH, Armbruster T (1985) Childhood urolithiasis in
Iran: a comprative study on the calculi composition of 121 cases.
Z Kinderchir 40:163169