Chang Jei-Wen, Yang Hui-Hsin, Lin Tzu-Ching, Kuo Fang-Cheng, Fan Yu-Hua, Chen Hsin-Hung, Yang Ling-Yu, Liu Chin-Su, Tsai Hsin-Lin
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2025 Feb 1;88(2):156-161. doi: 10.1097/JCMA.0000000000001172. Epub 2024 Sep 20.
While many studies have reported the renal outcomes and metabolic consequences of augmentation cystoplasty (AC), few have focused on changes in renal tubular function. This study investigated the prevalence of metabolic disturbances, renal tubular function, and 24-hour urine chemistry, aiming to evaluate the association between metabolic alterations and urolithiasis after AC.
We investigated serum biochemistry, blood gas, and 24-hour urinary metabolic profile of children who underwent AC between January 2000 and December 2020. The assessed outcomes included metabolic complications, tubular function, and magnesium status. Associations between 24-hour urinary metabolic parameters and urolithiasis formation were also examined.
A total of 25 patients with a mean follow-up period of 13.8 ± 5.7 years were enrolled. The mean age at AC was 7.5 ± 4.4 years, and 22 and 3 patients underwent AC using the ileum and colon, respectively. There were no abnormalities in serum levels of sodium, potassium, chloride, and calcium. Hypomagnesemia (magnesium <1.7 mg/dL) due to renal loss was observed in one patient (4.0%). Six (24.0%) patients had increased urinary β2-microglobulin levels and normal serum levels. The ratio of the maximum rate of tubular phosphate reabsorption to the glomerular filtration rate was low in three (12.0%) patients. Four (16.0%) patients had normal serum magnesium levels but urinary magnesium excretion <40 mg/d. Urolithiasis occurred in 11 patients (44.0%). The most common 24-hour urine metabolic abnormality was hypomagnesiuria (72.0%). No urinary metabolic parameters or daily protein intake were associated with urolithiasis.
AC for children is safe and does not significantly impact the metabolic profile. Excretions of 24-hour urinary calcium, uric acid, magnesium, and the sodium-to-potassium ratio were not associated with urolithiasis. However, a high prevalence of 24-hour urine magnesium excretion <88 mg/1.73 m 2 was noted. Further prospective studies are needed to investigate longitudinal changes in renal tubular function and 24-hour urine metabolic profiles, particularly magnesium status.
虽然许多研究报告了扩大膀胱成形术（AC）的肾脏结局和代谢后果，但很少有研究关注肾小管功能的变化。本研究调查了代谢紊乱、肾小管功能和24小时尿液化学指标的患病率，旨在评估AC后代谢改变与尿路结石之间的关联。
我们调查了2000年1月至2020年12月期间接受AC的儿童的血清生化、血气和24小时尿液代谢谱。评估的结局包括代谢并发症、肾小管功能和镁状态。还检查了24小时尿液代谢参数与尿路结石形成之间的关联。
共纳入25例患者，平均随访时间为13.8±5.7年。AC时的平均年龄为7.5±4.4岁，分别有22例和3例患者使用回肠和结肠进行AC。血清钠、钾、氯和钙水平无异常。1例患者（4.0%）因肾性丢失出现低镁血症（镁<1.7mg/dL）。6例（24.0%）患者尿β2-微球蛋白水平升高而血清水平正常。3例（12.0%）患者肾小管磷重吸收率与肾小球滤过率之比低。4例（16.0%）患者血清镁水平正常但尿镁排泄<40mg/d。11例患者（44.0%）发生尿路结石。最常见的24小时尿液代谢异常是低镁尿症（72.0%）。没有尿液代谢参数或每日蛋白质摄入量与尿路结石相关。
儿童AC是安全的，对代谢谱没有显著影响。24小时尿钙、尿酸、镁排泄及钠钾比与尿路结石无关。然而，注意到24小时尿镁排泄<88mg/1.73m²的患病率较高。需要进一步的前瞻性研究来调查肾小管功能和24小时尿液代谢谱的纵向变化，特别是镁状态。
