Department of Pediatrics, The Institute of Kidney Disease, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
Acta Paediatr. 2011 Aug;100(8):e71-4. doi: 10.1111/j.1651-2227.2011.02191.x. Epub 2011 Mar 1.
To evaluate the therapeutic effect of hydrochlorothiazide in idiopathic renal hypercalciuria.
We retrospectively analysed the data of 28 children (6.0±4.1 years, M:F=19:9) diagnosed as having idiopathic renal hypercalciuria from the years 1991 to 2008. The dose of hydrochlorothiazide was initially 0.5 mg/kg/day and gradually increased to achieve the appropriate hypocalciuric effect (urinary calcium/creatinine<0.2 mg/mg) in some unresponsive patients.
Twenty-two patients (79%) had gross haematuria, 6 (21%) microscopic haematuria, 2 left flank pain, 6 (21%) urolithiasis and 9 (32%) urinary tract infection at the diagnosis of hypercalciuria. The low doses (0.5 mg/kg/day) of hydrochlorothiazide reduced urinary calcium excretion in 25 patients (89%) and 3 (11%) required the increased doses (1-2 mg/kg/day). Haematuria and urolithiasis gradually resolved in accordance with the improvement of hypercalciuria. Nineteen patients (68%) maintaining hypocalciuria during hydrochlorothiazide therapy were discontinued after 12.5±5.3 months of treatment. Eleven of the 19 patients maintained normocalciuria, while 8 showed increased urinary calcium excretion at 2.9±2.3 months after treatment was stopped, requiring thiazide retreatment.
Our results suggest that low dose (0.5 mg/kg/day) of hydrochlorothiazide may be safe and effective in controlling renal hypercalciuria in children.
评估氢氯噻嗪治疗特发性肾性高钙尿症的疗效。
我们回顾性分析了 1991 年至 2008 年期间诊断为特发性肾性高钙尿症的 28 例儿童（6.0±4.1 岁，男：女=19：9）的数据。氢氯噻嗪的初始剂量为 0.5mg/kg/天，在一些无反应的患者中逐渐增加剂量，以达到适当的低钙尿效果（尿钙/肌酐<0.2mg/mg）。
22 例患者（79%）有肉眼血尿，6 例（21%）有镜下血尿，2 例有左侧腰痛，6 例（21%）有尿路结石，9 例（32%）有尿路感染。低剂量（0.5mg/kg/天）的氢氯噻嗪降低了 25 例患者（89%）的尿钙排泄，3 例（11%）需要增加剂量（1-2mg/kg/天）。血尿和尿路结石随着高钙尿症的改善逐渐缓解。19 例（68%）患者在接受氢氯噻嗪治疗期间保持低钙尿，治疗 12.5±5.3 个月后停药。19 例中有 11 例继续保持正常尿钙排泄，而有 8 例在停药后 2.9±2.3 个月出现尿钙排泄增加，需要再次使用噻嗪类药物治疗。
我们的结果表明，低剂量（0.5mg/kg/天）的氢氯噻嗪可能是安全有效的，可控制儿童的肾性高钙尿症。
