Pediatric Department, University of Verona, Verona, Italy.
J Urol. 2012 Aug;188(2):566-70. doi: 10.1016/j.juro.2012.04.019. Epub 2012 Jun 15.
Intestinal malabsorption can cause urinary stone disease via enteric hyperoxaluria. It has been shown that celiac disease, a common malabsorption disorder, is associated with an increased risk of calcium oxalate kidney stones in adults. Since no published data are available in the pediatric population, we analyzed urinary excretion of electrolytes in children with celiac disease to assess the risk of nephrolithiasis.
The study population consisted of 115 children 1 to 16 years old (mean 5 years) with positive serological tests for celiac disease (anti-endomysium and anti-tissue transglutaminase antibodies) referred to us for jejunal biopsy to confirm the diagnosis. Assessment was requested because patients presented with poor growth, anemia, gastrointestinal disorders or a family history of celiac disease. After obtaining informed consent we performed urine tests to measure urinary variables and blood tests to exclude metabolic disorders and evaluate renal function.
All patients had a biopsy confirmed diagnosis of celiac disease. Oxaluria was normal in all children studied. However, levels of urinary calcium were decreased in patients with celiac disease and were inversely associated with disease severity (p = 0.0004).
In contrast to adults, increased urinary excretion of oxalate was not detectable in children presenting with celiac disease. Therefore, the risk of nephrolithiasis appears not to be increased compared to healthy children. The observed hypocalciuria probably further decreases the tendency to form kidney stones.
肠吸收不良可通过肠源性高草酸尿导致尿路结石病。已有研究表明，乳糜泻（一种常见的吸收不良性疾病）与成人草酸钙肾结石的风险增加相关。由于在儿科人群中尚无发表的数据，我们分析了乳糜泻患儿的尿液电解质排泄情况，以评估肾结石形成的风险。
研究人群包括 115 名 1 至 16 岁（平均 5 岁）的儿童，这些儿童的血清学检测抗肠内膜和抗组织转谷氨酰胺酶抗体呈阳性，因疑似乳糜泻而接受空肠活检以明确诊断。之所以进行评估，是因为患者表现为生长不良、贫血、胃肠道疾病或乳糜泻家族史。在获得知情同意后，我们进行了尿液检查以测量尿液变量，进行血液检查以排除代谢紊乱并评估肾功能。
所有患者的活检均证实患有乳糜泻。所有研究儿童的草酸尿均正常。然而，乳糜泻患者的尿钙水平降低，且与疾病严重程度呈负相关（p = 0.0004）。
与成人不同，患有乳糜泻的儿童未检测到尿液中草酸排泄增加。因此，与健康儿童相比，肾结石形成的风险似乎并未增加。观察到的低钙尿症可能进一步降低了形成肾结石的倾向。
