Garcia C D, Miller L A, Stapleton F B
Department of Nephrology, Children's Hospital of Buffalo, State University of New York 14222.
Am J Dis Child. 1991 Oct;145(10):1204-7. doi: 10.1001/archpedi.1991.02160100136039.
Hypercalciuria (HCU) is frequently found during the evaluation of children with hematuria; the long-term implications of untreated HCU in children are uncertain. Since 1981, we have identified HCU (urinary calcium, greater than 0.1 mmol.kg-1.d-1) in 58 patients (41 male) with hematuria; 64% had gross hematuria and 74% had a relative with urolithiasis. Renal HCU was diagnosed in 19 patients and absorptive HCU in 24 patients. In 15 children, the calcium loading test was nondiagnostic. In nine patients (16%), urolithiasis developed, and in one patient, a renal calcification developed. These 10 patients (seven male) were older (10.1 vs 7.5 years) than the other 48 patients and initially presented with gross hematuria (nine of 10). All 10 patients had a family history of urolithiasis. The initial urinary calcium value was similar between the 10 patients with stones (0.15 mmol.kg-1.d-1) and the patients without stones (0.14 mmol.kg-1.d-1); five had absorptive HCU and four had renal HCU. At least one follow-up urinary calcium measurement was available for 23 patients who were not receiving thiazide therapy during 1 to 6 years after diagnosis (mean, 3.1 years). At 1-year follow-up, 12 of 17 patients had HCU and five had hematuria. Twenty-one patients were studied 2 to 3 years from diagnosis; 11 had HCU and eight had hematuria. After 4 years, six of seven patients had HCU and three had hematuria. We concluded that children with HCU and hematuria are at significant risk for urolithiasis, especially if they have gross hematuria and a family history of urolithiasis. Hypercalciuria may be episodic in children with hematuria, and factors other than urinary calcium concentration may be responsible for urinary bleeding.
高钙尿症（HCU）在血尿患儿的评估过程中经常被发现；未经治疗的儿童HCU的长期影响尚不确定。自1981年以来，我们在58例血尿患儿（41例男性）中发现了HCU（尿钙大于0.1 mmol·kg⁻¹·d⁻¹）；64%的患儿有肉眼血尿，74%的患儿有尿路结石家族史。19例患儿被诊断为肾性HCU，24例为吸收性HCU。15例患儿的钙负荷试验无诊断意义。9例患儿（16%）发生了尿路结石，1例患儿出现了肾钙化。这10例患儿（7例男性）比其他48例患儿年龄更大（10.1岁对7.5岁），最初均表现为肉眼血尿（10例中有9例）。所有10例患儿均有尿路结石家族史。10例有结石的患儿与无结石的患儿初始尿钙值相似（分别为0.15 mmol·kg⁻¹·d⁻¹和0.14 mmol·kg⁻¹·d⁻¹）；5例为吸收性HCU，4例为肾性HCU。在诊断后的1至6年（平均3.1年），至少有一次随访尿钙测量结果可供23例未接受噻嗪类治疗的患儿使用。在1年随访时，17例患儿中有12例有HCU，5例有血尿。从诊断开始2至3年对21例患儿进行了研究；11例有HCU，8例有血尿。4年后，7例患儿中有6例有HCU，3例有血尿。我们得出结论，患有HCU和血尿的儿童有发生尿路结石的显著风险，特别是如果他们有肉眼血尿和尿路结石家族史。血尿患儿的高钙尿症可能是间歇性的，除尿钙浓度外的其他因素可能是血尿的原因。
