Renal Hiperkalsiürili Çocuklar ve Ebeveynlerinde Hipertansiyon Riski

Year 2010, , 126 - 132, 01.07.2010

Dicle Şener Şeyma Ekmekçi Ahmet Nayır Sema Cantez

https://doi.org/10.5222/j.child.2010.126

Abstract

Amaç: Hiperkalsiürili çocuklar ve ebeveynlerinde sessiz seyreden hipertansiyon riskini araştırmak.Gereç ve Yöntem: Hiperkalsiüri tanısıyla takipli, 3-10 yaş arası 20 çocuk ve ebeveynleri çalışmaya kabul edildi. Çocukların ve ebeyenlerinin 24 saatlik arteriyel kan basınçları holter cihazı ile ölçüldü. Vakaların böbrek fonksiyon testleri, serum elektrolitleri, serum alkalen fosfataz, kalsiyum, fosfor, parathormon, osteokalsin, kalsitriol düzeyleri, idrar kalsiyum/kreatinin, 24 saatlik idrar kalsiyum atılımları incelendi. Çocukların ve ebeyenlerinin kemik yoğunluk ölçümleri yapıldı.Bulgular: Çocuklar sistolik kan basınçlarına göre; %15 hipertansif, %60 prehipertansif; diyastolik kan basınçlarına göre %30 prehipertansif bulundu. Annelerin %15’i prehipertansif, babaların da %10’u hipertansif, %40’ı prehipertansifti. Çocuklarda hipertansiyon riskinin, hiperkalsiüri derecesinden bağımsız olarak arttığı görüldü. Hiperkalsiürili çocuklarda ve ebeveynlerinde, kemik yoğunlukları incelendiğinde babaların femur boynu kemik mineral yoğunlukları ile gündüz ortalama sistolik, sabah erken ortalama sistolik, sabah erken ortalama diyastolik kan basınçları arasında negatif yönde ilişki saptandı. Hipertansiyon ve kemik metabolizması arasındaki bu ilişki, çocuklarda osteokalsin düzeyleri ile desteklendi. Sonuç: Hiperkalsiüri sistemik bir hastalık olarak kabul edilmeli, hastalar hipertansiyon ve osteoporoz riski açısından da yakından izlenmelidir

Keywords

Hiperkalsiüri, hipertansiyon, osteoporoz, osteokalsin, kalsiyum, fosfor, sodyum, urolithiazis

Risk of Hypertension in Children and Parents with Renal Hypercalciuria

Abstract

Aim: The aim of the study is to determine the risk of silent hypertension in children and parents with renal hypercalciuria Material and Method: 20 children diagnosed by Istanbul University Faculty of Medicine, Department of Pediatric Nephrology as renal hypercalciuria, and also their parents were included in the study. Their 24-hour blood pressures were measured with a Holter device. Renal function tests, serum electrolyte values, alkaline phosphatase, calcium, phosphorus, parathormone, osteocalcine, calcitriol levels, urinary calcium / creatinin Ca/Cr ratios and daily urinary calcium excretions were investigated. Bone density measurements of children and parents were done.Results: According to the total average systolic blood pressure, the children were categorized as hypertensive 15 % , and prehypertensive 60 % . According to the total average diastolic blood pressures, they were categorized as prehypertensive 30 % , while 15 % of mothers and 10 % of fathers were hypertensive, and 40 % of them were prehypertensive We determined increased risk of hypertension in children with renal hypercalciuria, regardless of the degree of hypercalciuria. When bone densities of children and parents with hypercalciuria were investigated, we found a negative correlation between father’s femoral neck bone mineral density and their daytime average systolic, early morning average systolic and early morning average diastolic blood pressures. The relationship between hypertension and bone metabolism was supported by osteocalcin levels in the pediatric group. Conclusion: Renal hypercalciuria must be seen as a systemic disorder and patients shoud be followed regarding hypertension and osteoporosis

Keywords

Renal hypercalciuria, hypertension, osteoporosis, osteocalcin, calcium, phosphorus, sodium, renal calculi

References

• Coe FL, Parks JH. Familial (idiopathic) hypercalciuria: Nephrolithiasis, Pathogenesis and Treatment, 2nd edition, 1008-1038, Yearbook Medical Publishers Inc., Chicago, 1998.
• Idiopathic hypercalciuria: a preliminary report. Proc R Soc Med, 1953; 46:1077-81.
• Molitch M, Krutzick S. Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak. Hypertension, 1980; 2:162-8.
• um metabolism in essential hypertension. Clin Sci, 1983; 65:137-41.
• pathophysiological aspects and clinical implications. Nutr Metab Cardiovasc Dis 1991; 1:98-103.
• blood pressure and bone-mineral loss in elderly white women: a prospective study. Lancet, 1999; 354:971-5.
• longitudinal study of total and regional bone mineral content and biochemical markers of bone resorption in patients with idiopathic hypercalciuria on thiazide treatment. Miner Electrolyte Metab, 1993; 19(6):337-42.
• Thiazide effect on the mineral content of bone. N Engl J Med, 1983; 11:309(6):344-7.
• Relationship between calcium metabolic indices and blood pressure in patients with essential hypertension as compared with healthy population. J Hypertens, 1987; 5:451-6.
• excretion in essential hypertension. J Lab Clin Med, 1992; 120:624-32.
• Raised plasma intact parathyroid hormone concentrations in young people with mildly raised blood pressure. BMJ, 1988; 296:814-6.
• ML. Calcitropic hormones, platelet calcium and blood pressu- re in essential hypertension. Hypertension, 1990; 16:515-22.
• Gadallah M, Massry SG, Bigazzi R, Horst RL, Eggena P, Campese VM. İntestinal absorption of calcium and calcium metabolism in patients with essential hypertension and normal renal function. Am J Hypertension, 1991; 4:404-9.
• (NCCT): a potential genetic link between blood pressure and bone density? Nephrol Dial Transplant, 2001; 16:691-4.
• LaCroix AZ, Weinpahl J, White LR. Thiazide diuretic agents and the incidence of hip fracture. N Engl J Med, 1990; 322:286-90.
• Thiazide diuretics and the risk of hip fracture: results from the Framingham study. JAMA, 1991; 265:370-3.
• diuretic therapy on bone mass, fractures and falls. Ann Intern Med, 1993; 118:666-73.
• rates of bone mineral loss: a longitudinal study. BMJ, 1990; 301:1303-5.
• mass in hypercalciuric, osteoporotic men tretated with hydrochlorothiazide. Ann Intern Med, 1999; 130:658-60.
• Laroche M, Mazieres B. Benefical effect of a thiazide diure- tic on bone mineral density in male osteoporosis with hyper- calciuria. Clin Exp Rheumatol, 1998; 16:109-10.
• Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults: a randomized, double-blind, placebo-controlled trial. Ann Intern Med, 2000; 133:516-21.
• London GM, Safar ME, Simon AC, Alexander JM, Levenson JA, Weiss YA. Total effective compliance, cardiac output and fluid volumes in essential hypertension. Circulation, 1978; 57:995-1000.
• Pediatr Rev, 2004; 25:131-9.
• pathic renal hypercalciuria. Arch Dis Child, 1989; 64:1055-7. 25. Kruse K, Kracht U, Kruse U. Reference values for urinary calcium excretion and screening for hypercalciuria in children and adolescents. Eur J Pediatr, 1984; 143:25-31.
• rında asemptomatik hiperkalsiüri: epidemiyoloji ve patoge- nez. Çocuk Sağlığı ve Hastalıkları Dergisi, 1989; 32:43-50.
• Levy FL, Adams Huet B, Pak CY. Ambulatory evaluation of nephrolithiasis: an update of a1980 protocol. Am J Med, 1995; 98:50-9
• calcium excretion in normal persons and stone-formers. Clin Chim Acta, 1972; 37:503-8.
• Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int, 2001; 59:2290-8. 30. Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest, 2005; 115:2598-608
• Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Family history and risk of kidney stones. J Am Soc Nephrol, 1997; 8:1568-73.
• R. Clinical presentation and natural course of idiopathic hypercalciuria in children. Pediatr Nephrol, 2000; 15:211-4.