Urinary calcium and uric acid excretion in children with vesicoureteral reflux |
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| Authors: | Abbas Madani Nooshin Kermani Neamatollah Ataei Seyed Taher Esfahani Niloufar Hajizadeh Zahra Khazaeipour Sima Rafiei |
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| Institution: | (1) Department of Pediatric Nephrology, Children’s Hospital Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran;(2) Brain and Spinal Injury Repair Research Center of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran;(3) Department of Management and Health Economics, Health faculty, Tehran University of Medical Sciences, Tehran, Iran;(4) Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran; |
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| Abstract: | Urolithiasis is relatively common in children, and identifiable predisposing factors for stone formation, including metabolic
and structural derangements, can be established in most cases. Vesicoureteral reflux (VUR) is a common cause of kidney stone
formation. The pathophysiological mechanism of urolithiasis in reflux is related to urinary tract infection and urinary stasis,
both of which promote urinary crystal formation, but metabolic causes, such as crystallurias (mostly hypercalciuria), may
also be involved in this process. However, few studies on urinary calcium and uric acid excretion in children with VUR have
been conducted. We have studied the frequency of hypercalciuria and hyperuricosuria in children with VUR and compared the
results with those from a control group. The VUR group comprised 108 children with VUR (19 boys, 89 girls; age range 3 months
to 12 years), and the control group comprised 110 healthy children without any history of reflux or urinary tract infection
(30 boys, 80 girls; age range 2 months to 12 years). Fasting urine was analyzed for the calcium/creatinine (Ca/Cr) and uric
acid/creatinine (UA/Cr) ratios. Hypercalciuria was more frequently diagnosed in the VUR patients than in the control group
(21.3 vs. 3.6%; P = 0.0001). Significant differences between the two groups were also found for the mean Ca/Cr and UA/Cr ratios (P = 0.0001 and P = 0.0001, respectively). No differences were found in the urinary Ca/Cr or UA/Cr ratios related to VUR grading or unilateral/bilateral
VUR in the patient group, with the exception of those for hypercalciuria and mild VUR (P = 0.03). The association of urinary stones and microlithiasis in the VUR group was 29.6%. Our results demonstrate that the
frequency of hypercalciuria and hyperuricosuria was higher in pediatric patients with VUR than in healthy children. Knowing
this relationship, preventive and therapeutic interventions for stone formation in VUR could be greatly expanded. |
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