Balestracci Alejandro, Meni Battaglia Luciana, Toledo Ismael, Martin Sandra Mariel, Wainsztein Raquel Eva
Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires.
Arch Argent Pediatr. 2014 Oct;112(5):428-33. doi: 10.5546/aap.2014.eng.428.
Idiopathic hypercalciuria (IH) predisposes to urinary tract infections (UTIs); however, there is scarce local information regarding such association. Our objectives were to estimate IH prevalence in children with UTI and to assess whether there were differences in relation to the presence or absence of vesicoureteral reflux (VUR). Additionally, the association between IH and salt intake was studied.
Calciuria was determined in patients younger than 18 years old on whom UTI had been studied (ultrasound and voiding cystourethrogram), and who had no secondary causes of hypercalciuria. IH was defined as a calcium to creatinine ratio of >0.8, 0.6, 0.5 and 0.2 in children aged 0 to 6 months old, 7 to12 months old, 12 to 24 months old and older than 2 years old, respectively; and a high sodium intake with a urinary sodium to potassium ratio of >2.5.
IH prevalence among 136 patients (87 girls, median age: 3 years old) was 20%. Patients with VUR (n= 54) and without VUR (n= 82) had similar characteristics in terms of sex, weight, height, age at diagnosis and age at the time of the study, and clinical features (hematuria, nephrolithiasis, colicky pain, and recurrent UTI), family history of kidney stone formation, and IH prevalence (26% versus 16%, p= 0.24). A high sodium intake was more frequently observed in children with hypercalciuria than in those with normal urine calcium levels (76% versus 46%, p= 0.007).
IH prevalence in children with UTI was high (20%), with no differences observed between patients with and without VUR. As a recommendation, the presence of IH should be detected in children with UTI, regardless of VUR presence or absence.
特发性高钙尿症（IH）易引发尿路感染（UTI）；然而，关于这种关联的本地信息稀缺。我们的目标是估计UTI患儿中IH的患病率，并评估是否存在膀胱输尿管反流（VUR）与IH患病率之间的差异。此外，还研究了IH与盐摄入量之间的关联。
对年龄小于18岁、已接受UTI检查（超声和排尿性膀胱尿道造影）且无高钙尿症继发原因的患者测定尿钙。IH的定义为：0至6个月龄儿童钙与肌酐比值>0.8，7至12个月龄儿童>0.6，12至24个月龄儿童>0.5，2岁以上儿童>0.2；以及尿钠与钾比值>2.5表示高钠摄入。
136例患者（87例女孩，中位年龄：3岁）中IH患病率为20%。有VUR（n = 54）和无VUR（n = 82）的患者在性别、体重、身高、诊断年龄和研究时年龄以及临床特征（血尿、肾结石、绞痛和复发性UTI）、肾结石形成家族史和IH患病率方面具有相似特征（分别为26%和16%，p = 0.24）。高钙尿症患儿比尿钙水平正常的患儿更常出现高钠摄入（分别为76%和46%，p = 0.007）。
UTI患儿中IH患病率较高（20%），有VUR和无VUR的患者之间未观察到差异。建议无论是否存在VUR，UTI患儿均应检测是否存在IH。
