ABSTRACT
Introducción: La hipercalciuria idiopática es un trastorno metabólico frecuente y poco reconocido, cuyo curso clínico depende en gran medida de cambios en los hábitos dietéticos desde la infancia. Objetivo: Caracterizar a niños y adolescentes con hipercalciuria idiopática según variables clínicas, epidemiológicas y terapéuticas. Métodos: Se realizó una investigación observacional, longitudinal y prospectiva de 44 pacientes con hipercalciuria idiopática, atendidos en el Servicio de Miscelánea del Hospital Pediátrico Docente Sur Antonio María Béguez César de Santiago de Cuba, desde enero de 2014 hasta diciembre de 2015. Resultados: Las formas sintomáticas de la enfermedad resultaron ser las más frecuentes (68,2 %); asimismo, predominó el sexo masculino (72,7 %) y el promedio de edad fue de 7,2 ± 4 años. Existió asociación estadística entre las edades preescolar y escolar en cuanto al diagnóstico de hipercalciuria idiopática. La hematuria macroscópica recurrente fue el síntoma más usual en la mayoría de los casos (59,1 %); en tanto, 25,0 % de los pacientes presentó litiasis renal y el tratamiento no farmacológico a base de líquidos y dieta se relacionó con una evolución satisfactoria en 68,2 % de los afectados, a pesar de que el restante 31,8 % necesitó tratamiento medicamentoso. Conclusiones: Las características clínicas y epidemiológicas de los pacientes con hipercalciuria idiopática de esta casuística no difirieron de las registradas a nivel mundial, considerando que este trastorno metabólico es relativamente frecuente en los servicios de pediatría.
Introduction: The idiopathic hypercalciuria is a frequent and not very recognized metabolic disorder which clinical course depends in great extent on changes in the dietary habits from the childhood. Objective: To characterize children and adolescents with idiopathic hypercalciuria according to the clinical, epidemiological and therapeutic variables. Methods: An observational, longitudinal and prospective investigation was carried out in 44 patients with idiopathic hypercalciuria, assisted in the Miscellaneous Service of Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba, from January, 2014 to December, 2015. Results: The symptomatic forms of the disease were the most frequent (68.2 %); also, the male sex prevailed (72.7 %) and the average age was 7.2 ± 4 years. Statistical association existed among the preschool and school ages as for the diagnosis of idiopathic hypercalciuria. The recurrent macroscopic hematuria was the most usual symptom in the majority of cases (59.1 %); as long as, the 25.0 % of patients presented renal lithiasis and the diet and liquids-based non pharmacological treatment was associated with a satisfactory evolution in 68.2 % of the affected patients, although the remaining 31.8 % needed drugs treatment. Conclusions: The clinical and epidemiological characteristics of patients with idiopathic hypercalciuria of this case material didn't differ from the ones registered worldwide, taking into account that this metabolic disorder is relatively frequent in pediatric services.
Subject(s)
Nephrolithiasis/therapy , Hypercalciuria/diagnosis , Hypercalciuria/epidemiology , Child , Adolescent , Hypercalciuria/therapy , Hospitals, PediatricABSTRACT
Idiopathic hypercalciuria may be associated with urinary tract infection, hematuria, nephrolithiasis and osteopenia. In order to describe the occurrence of these concurrent conditions related to the variation in urinary calcium and hypercalciuria response to sequential therapy, with a normal protein and low sodium diet, potassium citrate and hydrochlorothiazide; 46 patients older than 4 years, with no urinary tract diseases, sphincter control and normal blood creatinine values were followed-up during 43 months. Hypercalciuria was seen to be associated with kidney stones (EAR 47%; RR 3.3), hematuria (EAR 71%; RR 2.5), urinary tract infections (EAR 57%; RR 3), and osteopenia (EAR 33%; RR 3). A normal value of urinary calcium was achieved with sequential therapy in 43 patients, but during follow-up 32 patients discontinued treatment and hypercalciuria recurred in 44% of them, in association with hematuria and urinary tract infection. Conclusions. Sequential therapy reduced hypercalciuria and the incidence of associated diseases.
La hipercalciuria idiopática puede asociarse con infección urinaria, hematuria, nefrolitiasis y osteopenia; con los objetivos de describir la aparición de estas patologías concurrentes, relacionadas con la variación del calcio urinario y la respuesta al tratamiento secuencial de la hipercalciuria, con dieta normoproteica-hiposódica, citrato de potasio e hidroclorotiazida, controlamos durante 43 meses a 46 pacientes mayores de 4 años, sin uropatías, con control esfinteriano y creatininemias normales. Observamos que la hipercalciuria se asoció con litiasis renal (RAE 47%; RR 3,3); hematuria (RAE 71%; RR 2,5); infecciones urinarias (RAE 57%; RR 3) y osteopenia (RAE 33%; RR 3). La terapéutica secuencial normalizó el calcio urinario en 43 pacientes, pero durante el seguimiento, 32 interrumpieron el tratamiento y la hipercalciuria reapareció en 44% de ellos, asociada a hematuria e infección urinaria. Conclusiones. El tratamiento secuencial redujo la hipercalciuria y disminuyó la incidencia de patologías asociadas.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Hypercalciuria/complications , Hypercalciuria/therapy , Retrospective StudiesABSTRACT
TRPV5 is believed to play an important role in the regulation of urinary calcium excretion. We assessed the effects of hydrochlorothiazide (HCTZ) on the expression of TRPV5, calbindin-D28K, and several sodium transporters in hypercalciuric rats. Sprague- Dawley rats were divided into 4 groups; control, HCTZ, high salt, and high salt with HCTZ group in experiment 1; control, HCTZ, high calcium (Ca), and high Ca with HCTZ group in experiment 2. To quantitate the expression of TRPV5, calbindin- D28K, and sodium transporters, western blotting was performed. In both experiments, HCTZ significantly decreased urinary calcium excretion. TRPV5 protein abundance decreased in all hypercalciuric rats, and restored by HCTZ in both high salt with HCTZ and high Ca with HCTZ group. Calbindin-D28K protein abundance increased in the high salt and high salt with HCTZ groups, but did not differ among groups in experiment 2. Protein abundance of NHE3 and NKCC2 decreased in all hypercalciuric rats, and were restored by HCTZ in only high Ca-induced hypercalciuric rats. In summary, protein abundance of TRPV5, NHE3, and NKCC2 decreased in all hypercalciuric rats. The hypocalciuric effect of HCTZ is associated with increased protein abundance of TRPV5 in high salt or calcium diet-induced hypercalciuric rats.