Risk factors for urolithiasis in children on the ketogenic diet |
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Authors: | S L Furth J C Casey P L Pyzik A M Neu S G Docimo E P G Vining J M Freeman B A Fivush |
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Institution: | (1) Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Park 327, Baltimore, MD 21287–2535, USA e-mail: sfurth@jhmi.edu Tel.: +1-410-9552467, Fax: +1-410-6143680, US;(2) Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, US;(3) Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, US;(4) Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, US |
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Abstract: | Kidney stones have been associated with use of the ketogenic diet in children with refractory seizure disorders. We performed
a case-control study examining risk factors for the development of stones on the ketogenic diet, and prospectively followed
children initiating the ketogenic diet to evaluate the incidence of urolithiasis. Clinical characteristics of 18 children
presenting with stones (8 uric acid stones, 6 mixed calcium/uric acid stones, 1 calcium oxalate/phosphate stone, 3 stones
not evaluated) were compared with characteristics of non-stone-forming children initiating the ketogenic diet at Johns Hopkins
since July 1996. Since July 1996, 112 children initiating the ketogenic diet have been followed for development of stones.
Follow-up times on the diet range from 2 months to 2.5 years. Of 112 children, 6 have developed stones (3 uric acid, 3 mixed
calcium/uric acid stones) (0.8 children developing stones/ 100 patient-months at risk). Comparisons of children presenting
with stones on the ketogenic diet with characteristics of the entire cohort initiating the ketogenic diet suggest younger
age at diet initiation and hypercalciuria are risk factors for the development of stones. Prospective evaluation of children
initiating the ketogenic diet revealed that almost 40% of patients had elevated fasting urine calcium: creatinine ratios at
baseline; this increased to 75% after 6 months on the diet. Median urine pH was 5.5 at diet initiation, and remained at 6.0
thereafter. In a subset of patients tested, urinary citrate excretion fell from a mean of 252 mg/24 h pre diet initiation
to 52 mg/24 h while on the diet. Uric acid excretion remained normal. Patients maintained on the ketogenic diet often have
evidence of hypercalciuria, acid urine, and low urinary citrate excretion. In conjunction with low fluid intake, these patients
are at high risk for both uric acid and calcium stone formation.
Received: 28 May 1999 / Revised: 7 June 2000 / Accepted: 9 June 2000 |
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Keywords: | Ketogenic diet Seizures Nephrolithiasis Hypercalciuria Hematuria |
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