Renal Hiperkalsiürili Çocuklarda Osteoporoz Sıklığı

Öz

Amaç : Renal hiperkalsiürili çocuklarda sessiz olarak seyreden, fazla önemsenmeyen osteoporoz sıklığını araştırmak amacıyla İTF Çocuk Nefroloji BD’de renal hiperkalsiüri tanısıyla takipli, 3-10 yaş arası 20 çocuk çalışmaya kabul edildi. Yöntemler: Kemik mineral yoğunlukları DEXA 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. Bulgular: Çocukların 5’i % 25 osteoporotik, 4’ü % 20 osteopenik bulundu. Kemik mineral yoğunlukları ile 24 saatlik idrar kalsiyum atılımları, spot idrar kalsiyum/kreatinin oranları arasında negatif yönde güçlü ilişki saptandı r= -0.587, p= 0.007 , r= -0.629, p= 0.03 . Sonuç: Sonuçlar şimdiye kadar yapılan benzer çalışmalarla karşılaştırıldı.Sonuçlarımız renal hiperkalsiürili hastalarda osteoporozun önemli bir sorun olduğunu göstermektedir.

Anahtar Kelimeler

• Hiperkalsiüri,osteoporoz,kalsiyum,fosfor,sodyum,urolithiazis

The Prevalence of Osteoporosis in Renal Hypercalciuric Children

Öz

Objective: To determine the prevalence of silent osteoporosis which is considered to be unimportant in renal hypercalciuric children, 20 children between 3-10 years of age who were followed by ITF Department of Pediatric Nephrology with the diagnosis of renal hypercalciuria included in the study. Methods: Bone mineral densities measured by DEXA scanner. Renal function tests; serum electrolit, alkaline phosphatase, calcium, phophorus, parathormone, calcitriol levels; urinary calcium to creatinin Ca/Cr ratios, daily urinary calcium excretions investigated. Results: Twenty-five percent of children were osteoporotic, and % 20 of them were osteopenic. Lumbar spine bone mineral density measurments were inversely correlated with urine Ca/Cr ratios r= -0.587, p=0.007 ; and daily urinary calcium levels r= -0.629, p=0.03 . Conclusion: Our results support the importance of osteoporosis in renal hypercalciuric children.

Anahtar Kelimeler

• Hypercalciuria,osteoporosis,calcium,phosphorus,sodium,renal calculi

Kaynakça

1. 1. Coe FL, Parks JH. Familial (idiopathic) hypercalciuria: Nephrolithiasis, Pathogenesis and Treatment, 2nd edition, 1008-1038, Yearbook Medical Publishers Inc., Chicago.1998.
2. 2. Albright F, Henneman P, Benedict PH, Forbes AP. Idiopathic hypercalciuria: a preliminary report. Proc R Soc Med 1953; 46:1077-81.
3. 3. WHO study group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: report of a WHO study group. WHO Technical Report Series 1994; 843, WHO, Geneva.
4. 4. Del Rio L, Carrascosa A, Pons F, Gussynié M, Yeste D, Domenech FM. Bone mineral density of the lumbar spine in Caucasian Meditterranean Spanish children and adolescents: changes releated to age, sex and puberty. Pediatr Res 1994; 35:362-6.
5. 5. Thomas KA, Cook SD, Bennett JT, Whitecoud III TS, Rice JC. Femoral neck and lumbar spine bone mineral densities in a normal population 3-20 years of age. J Pediatr Orthop 1991; 11:48-58.
6. 6. Lauderdale DS, Thisted RA, Wen M, Favus MJ. Bone mineral density and fracture among prevalent kidney stone cases in the Third National Health and Nutrition Examination Survey. J Bone Miner Res 2001; 16:1893-8.
7. 7. Vezzoli G, Soldati L, Gambaro G. Hypercalciuria revisited: one or many conditions? Pediatr Nephrol, 2008; 23:503-6.
8. 8. Moore ES, Coe FL, McMann BJ, Favus MJ. Idiopathic hypercalciuria in children: prevelance, and metabolic characteristics. J Pediatr 1978; 92:906-10.

9. 9. Gillespie RS, Stapleton FB. Nephrolithiasis in children. Pediatr Rev 2004; 25:131-9.
10. 10. Aqqarwal VK, Jones KV. Diffuse nephrocalcinosis and idiopathic renal hypercalciuria. Arch Dis Child 1989; 64:1055-7.
11. 11. Kruse K, Kracht U, Kruse U. Reference values for urinary calcium excretion and screening for hypercalciuria in children and adolescents. Eur J Pediatr 1948; 143:25-31.
12. 12. Buyan N, Saatçi Ü, Bakkaloglu A, Besbas N. Okul çocuklarında asemptomatik hiperkalsiüri: epidemiyoloji ve patogenez. Çocuk Sağlığı ve Hastalıkları Dergisi 1989; 32:43-50.
13. 13. Alon U, Warady BA, Hellerstein S. Hypercalciuria in the frequency-dysuria syndrome of childhood. J Pediatr 1990; 116:103-5.
14. 14. Stapleton FB, Roy S 3rd, Noe HN, Jerkins G. Hypercalciuria in children with hematuria. N Engl J Med 1984; 310:1345-8.
15. 15. Kaplan RA, Haussler MR, Deftos LJ, Bone H, Pak CY. The role of 1 alpha, 25-dihydroxyvitamin D in the mediation of intestinal hyperabsorption of calcium in primary hyperparathyroidism and absorptive hypercalciuria. J Clin Invest 1977; 59:756-60.
16. 16. Tenenhouse HS, Gauthier C, Chau H, St-Arnaud R. 1alpha-hydroxylase gene ablation and Pi supplementation inhibit renal calcification in mice homozygous for the disrupted Npt2a gene. Am J Physiol Renal Physiol 2004; 286:F675- F81.
17. 17. Levy FL, Adams Huet B, Pak CY. Ambulatory evaluation of nephrolithiasis: an update of a 1980 protocol. Am J Med 1995; 98:50-9.
18. 18. Robertson WG, Morgan DB. The distribution of urinary calcium excretion in normal persons and stone-formers. Clin Chim Acta 1972; 37:503-8.
19. 19. Polito C, La Manna A, Cioce F, Villani J, Nappi B, Di Toro R. Clinical presentation and natural course of idiopathic hypercalciuria in children. Pediatr Nephrol 2000; 15:211-4.
20. 20. Penido MG, Lima EM, Marino VS, Tupinamba AL, Franca A, Souto MF. Bone alterations in children with idiopathic hypercalciuria at the time of diagnosis. Pediatr Nephrol 2003; 18:133-9.
21. 21. Garcia-Nieto V, Ferrandez C, Monge M, de Sequera M, Rodrigo MD. Bone mineral density in pediatric patients with idiopathic hypercalciuria. Pediatr Nephrol 1997; 11:578-83.
22. 22. Freundlich M, Alonzo E, Bellorin-Font E, Weisinger JR. Reduced bone mass in children with idiopathic hypercalciuria and in their asymptomatic mothers. Nephrol Dial Transplant 2002; 17:1396-401.