Escribano Joaquin, Balaguer Albert, Martin Ramona, Feliu Albert, Espax Rosa
'Division of Pediatric Nephrology, Sant Joan University Hospital, Rovira i Virgili University, Reus, Spain.
Scand J Urol Nephrol. 2004;38(5):422-6. doi: 10.1080/00365590410033434.
To evaluate the clinical significance of renal calyceal microlithiasis (RCM) in children with idiopathic hypercalciuria (IHC).
RCM is a renal echographic finding defined as the presence of hyperechogenic spots < 3 mm in diameter in the renal calyces. These spots have been associated with the presence of nephrourological symptoms in children and are considered to represent a stage prior to urolithiasis. We reviewed the medical records of 103 children (63 girls, 40 boys; age range 1-14 years; mean age 6.57 years) referred for various complaints who had IHC. Renal echography was routinely performed. At diagnosis, 52 children had RCM, 35 showed normal echography, 14 had calculi and two presented nephrocalcinosis. A long-term follow-up study was carried out to compare the clinical manifestations, analytic data and renal echographic findings of patients with RCM and those with normal echography.
The clinical manifestations and the results of biochemical studies did not differ significantly between the two groups. Renal sonographic findings during the follow-up period revealed that, of patients with initial RCM, 35 showed normalized sonographic findings, two developed calculi and 36 developed recurrent RCM. Of the children with normal initial echography, 17 developed RCM and three developed calculi. The risk of developing lithiasis was less in children with RCM than in those with normal initial renal echography (0.04 vs 0.09), the relative risk being 0.45 (95% CI 0.08-2.55). The clinical and analytic differences between the group of 14 children with initial lithiasis and the other two groups previously described were also analyzed and no significant differences were found. An ongoing echographic study of these patients showed that the echograph was normalized in 10 children at some point or other, while seven developed RCM (four unilateral, three bilateral). In 13 cases the lithiasis reappeared, and the relative risk of recurrent lithiasis compared with those who initially showed no lithiasis was 16.16 (CI 95% 6.81-38.31).
Our results indicate that up to 85% of children with IHC presented RCM in follow-up sonographies. This echographic finding, which may appear and disappear at different points during follow-up, does not seem to indicate an increased risk of lithiasis.
评估小儿特发性高钙尿症（IHC）中肾盏微结石症（RCM）的临床意义。
RCM是一种肾脏超声检查结果，定义为肾盏内直径<3mm的高回声斑点。这些斑点与儿童的泌尿系统症状有关，被认为代表尿路结石形成的一个前期阶段。我们回顾了103例因各种主诉前来就诊且患有IHC的儿童（63例女孩，40例男孩；年龄范围1 - 14岁；平均年龄6.57岁）的病历。常规进行肾脏超声检查。诊断时，52例儿童有RCM，35例超声检查正常，14例有结石，2例有肾钙质沉着症。进行了一项长期随访研究，以比较RCM患者和超声检查正常患者的临床表现、分析数据及肾脏超声检查结果。
两组的临床表现和生化研究结果无显著差异。随访期间的肾脏超声检查结果显示，初始有RCM的患者中，35例超声检查结果恢复正常，2例发展为结石，36例发展为复发性RCM。初始超声检查正常的儿童中，17例发展为RCM，3例发展为结石。RCM患儿发生结石的风险低于初始肾脏超声检查正常的患儿（0.04对0.09），相对风险为0.45（95%可信区间0.08 - 2.55）。还分析了14例初始有结石的儿童组与之前描述的其他两组之间的临床和分析差异，未发现显著差异。对这些患者正在进行的超声检查研究表明，10例儿童在某个时间点超声检查恢复正常，而7例发展为RCM（4例单侧，3例双侧）。13例结石复发，与最初无结石的患者相比，结石复发的相对风险为16.16（95%可信区间6.81 - 38.31）。
我们的结果表明，在随访超声检查中，高达85%的IHC患儿出现RCM。这一超声检查结果在随访期间的不同时间点可能出现和消失，似乎并不表明结石形成风险增加。
