Penido MGMG, Tavares MS. Beyond kidney stones: Why pediatricians should worry about hypercalciuria. World J Clin Pediatr 2021; 10(6): 137-150 [PMID: 34868890 DOI: 10.5409/wjcp.v10.i6.137]
Corresponding Author of This Article
Maria Goretti Moreira Guimarães Penido, MD, PhD, Associate Professor, Chief Doctor, Professor, Pediatric Nephrology Unit, Nephrology Center, Santa Casa de Belo Horizonte Hospital, Rua Piauí 420, CEP 30150320, Belo Horizonte, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br
Research Domain of This Article
Pediatrics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Nov 9, 2021; 10(6): 137-150 Published online Nov 9, 2021. doi: 10.5409/wjcp.v10.i6.137
Beyond kidney stones: Why pediatricians should worry about hypercalciuria
Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares
Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares, Pediatric Nephrology Unit, Nephrology Center, Santa Casa de Belo Horizonte Hospital, CEP 30150320, Belo Horizonte, Minas Gerais, Brazil
Maria Goretti Moreira Guimarães Penido, Pediatric Nephrology Unit, Pediatric Department, Clinics Hospital, Universidade Federal de Minas Gerais, CEP 30130100, Belo Horizonte, Minas Gerais, Brazil
Author contributions: Penido MGMG and Tavares MS contributed equally to the conception and design of the study, the acquisition and interpretation of data, and the drafting and critical revision of the article.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Goretti Moreira Guimarães Penido, MD, PhD, Associate Professor, Chief Doctor, Professor, Pediatric Nephrology Unit, Nephrology Center, Santa Casa de Belo Horizonte Hospital, Rua Piauí 420, CEP 30150320, Belo Horizonte, Minas Gerais, Brazil. mariagorettipenido@yahoo.com.br
Received: March 26, 2021 Peer-review started: March 26, 2021 First decision: July 27, 2021 Revised: August 8, 2021 Accepted: October 31, 2021 Article in press: October 31, 2021 Published online: November 9, 2021
Abstract
The incidence of urolithiasis (UL) is increasing, and it has become more common in children and adolescents over the past few decades. Hypercalciuria is the leading metabolic risk factor of pediatric UL, and it has high morbidity, with or without lithiasis as hematuria and impairment of bone mass. The reduction in bone mineral density has already been described in pediatric idiopathic hypercalciuria (IH), and the precise mechanisms of bone loss or failure to achieve adequate bone mass gain remain unknown. A current understanding is that hypercalciuria throughout life can be considered a risk of change in bone structure and low bone mass throughout life. However, it is still not entirely known whether hypercalciuria throughout life can compromise the quality of the mass. The peak bone mass is achieved by late adolescence, peaking at the end of the second decade of life. This accumulation should occur without interference in order to achieve the peak of optimal bone mass. The bone mass acquired during childhood and adolescence is a major determinant of adult bone health, and its accumulation should occur without interference. This raises the critical question of whether adult osteoporosis and the risk of fractures are initiated during childhood. Pediatricians should be aware of this pediatric problem and investigate their patients. They should have the knowledge and ability to diagnose and initially manage patients with IH, with or without UL.
Core Tip: The incidence of pediatric urolithiasis is increasing, and hypercalciuria is its leading metabolic risk factor. The reduction in bone mass has already been described in hypercalciuric children, and the precise mechanisms of bone loss or failure to achieve adequate bone mass remain unknown. The peak bone mass is achieved by late adolescence, peaking at the end of the second decade of life. This accumulation should occur without interference. The bone mass acquired during childhood and adolescence is the major determinant of adult bone health. Pediatricians should have the knowledge and ability to diagnose and manage pediatric patients with idiopathic hypercalciuria.
