Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jul 25, 2021; 10(4): 47-58
Published online Jul 25, 2021. doi: 10.5527/wjn.v10.i4.47
Should pediatric idiopathic hypercalciuria be treated with hypocalciuric agents?
Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares
Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares, Pediatric Nephrology Unit, Nephrology Center of Santa Casa de Belo Horizonte, Belo Horizonte 30150320, Minas Gerais, Brazil
Maria Goretti Moreira Guimarães Penido, Federal University of Minas Gerais, Faculty of Medicine, Department of Pediatrics, Pediatric Nephrology Unit, Belo Horizonte 30130100, Minas Gerais, Brazil
Author contributions: Penido MGMG and Tavares MS contributed equally to the conception and design of the study, the acquisition, analysis and interpretation of data, and the drafting and critical revision of the final article.
Institutional review board statement: The study was approved by the institutional review board of the Clinics Hospital of the Federal University of Minas Gerais, Brazil (ETIC 0479.0.203.000-10, December 01, 2010) and by the Research Ethics Committee of Santa Casa de Belo Horizonte. It was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at: mariagorettipenido@yahoo.com.br. Participants gave informed consent for data sharing. Data are anonymized and there were no risk of identification.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Goretti Moreira Guimarães Penido, FRCP (Hon), MD, PhD, Associate Professor, Chief Doctor, Professor, Pediatric Nephrology Unit, Nephrology Center of Santa Casa de Belo Horizonte, Rua Piauí 420, Santa Efigênia, Belo Horizonte 30150320, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br
Received: March 30, 2021
Peer-review started: April 1, 2021
First decision: July 8, 2021
Revised: July 18, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: July 25, 2021
Processing time: 129 Days and 3.2 Hours
ARTICLE HIGHLIGHTS
Research background

Idiopathic hypercalciuria (IH) is the leading metabolic risk factor for pediatric urolithiasis. The reduction in bone mass has already been described in hypercalciuric children. Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life. A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown.

Research motivation

Considering that HI can cause a reduction in mineral bone density in children and adolescents and lead to osteopenia, osteoporosis, and an increased risk of fractures in adulthood, it would be important to know how to diagnose and treat this metabolic disorder.

Research objectives

Evaluated whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH.

Research methods

This is a retrospective cohort study that evaluated hypercalciuric children non-responsive to lifestyle and diet changes. They were treated with potassium Kcitrate or with Kcitrate combined to thiazides. Before and after treatment they underwent bone densitometry.

Research results

Forty IH children, median age 10.5 years and median time follow-up 6.0 years, were evaluated. Nine patients were treated with Kcitrate (G1) and 31 with Kcitrate + thiazide (G2). Calciuria decreased in both groups after treatment. Lumbar spine bone mineral density z-score increased after thiazide treatment in G2. There was no improvement in G1.

Research conclusions

Results point to a beneficial effect of thiazide on lumbar spine bone mineral density z-score in children with IH.

Research perspectives

Future perspectives are to understand better the pathogenesis of HI in order to treat children and adolescents, preventing bone mass reduction.