Afyonkarahisar Merkezindeki Sağlıklı Çocuklarda Spot İdrar Kalsiyum/Kreatinin Oranlarıyla ve 24 Saatlik İdrarla Kalsiyum Atılımının Değerlendirilmesi

Yıl 2007, Cilt: 5 Sayı: 2, 41 - 46, 01.09.2007

Tolga Altuğ Şen , Reşit Köken Tevfik Demir Hamide Melek Adnan Narcı

Öz

Amaç: Hiperkalsiüri çocuklarda çoğunlukla asemptomatik seyreden önemli bir sağlık sorunudur. Hiperkalsiüri çocuklardaki böbrek taşları için başlıca risk faktörlerindendir. Bu çalışmada çocuklarda ve özellikle bebeklerde 24 saatlik idrar toplanmasındaki güçlüklerden dolayı idrarla kalsiyum atılımının saptanması için spot idrar örneklerinde kalsiyum/kreatinin oranlarının değerlendirilmesini amaçladık. Gereç ve Yöntem: Çalışmamız için şubat 2001-Ocak 2003 tarihleri arasında, değişik nedenlerle polikliniğimize başvurmuş olan yaşları 4 ayla 16 yaş arasında değişen 1027 çocuk 516 kız, 511 erkek seçilmiştir. Bütün çocukların sabah ikinci idrar örnekleri alınmıştır. Kalsiyum/kreatinin oranı yüksek bulunan çocuklar arasından 24 saatlik idrar toplayabilecek durumda olanları için 24 saatlik idrar örnekleri toplamaları istenmiştir. Bulgular: Kız çocuklar için ortalama kalsiyum/kreatinin oranı 0,093 ±0,077, S.D. , erkek çocuklar içinse 0,104 ±0,075, S.D. olarak bulunmuş olup, erkeklerdeki oran anlamlı olarak yüksektir p=0,002 . Yaşları 4-12 ay arasında olan bebeler için kalsiyum/kreatinin oranı ortalama 0,203 ±0,121, S.D. , 13 ay- 6 yaş arasındaki küçük çocuklar için 0,133 ±0,081,S.D. , 7-11 yaş arasında büyük çocuklar için 0,095 ±0,071,S.D. ve 12-16 yaş arasındaki adölesanlar için 0,061 ±0,062, S.D. olarak tespit edilmiş olup, aradaki farklılıklar anlamlı bulunmutur p

Anahtar Kelimeler

Spot idrar kalsiyum/kreatinin oranı, 24 saatlik idrar kalsiyum atılımı, vücut-kitle indeksi, sağlıklı çocuklar

Evaluation of Spot Urine Calcium/Creatinine Ratio and 24-Hour Urinary Calcium Excretion in Healthy Children Living in Afyonkarahisar

Öz

Aim: Hypercalciuria is an important health problem especially during childhood. Hypercalciuria is usually asymptomatic, but it is a common risk factor in the formation of renal stones. In this study we evaluated urinary calcium excretion of infants and children. It is difficult to collect 24-hour urine samples especially for little children. Due to this difficulty random urine samples were evaluated and hypercalciuria was measured as the calcium / creatinine concentration ratio in the second non-fasting urine samples. Material and Methods: We selected 1027 children, 516 healthy girls and 511 healthy boys, aged 4 months to 16 years who were admitted to our clinic due to various simple complaints between February 2001 and January 2003. Each of them gave random urine sample for the assessment of calcium and creatinine excretion. When the calcium/creatinine ratio in random urine sample was high, 24-hour urine calcium collection for the calcium excretion was ordered. Results: The mean urinary calcium/creatinine ratio in girls was 0,093 ±0,077, S.D. ; in boys it was 0,104 ±0,075, S.D. ; boys had higher urine calcium/creatinine ratios than girls p=0,002 in all age groups. Infants to 4 months- 12 months old mean 0,203±0,121, S.D. , and small children, 13 months to 6 years old had higher urine calcium/creatinine ratios mean 0,133±0,081,S.D. than older children 7 - 11 years old, mean 0,095±0,071,S.D. and adolescents 12-16 years old, mean 0,061±0,062, S.D. p

Anahtar Kelimeler

Urinary calcium/creatinine ratio, 24-hour urine calcium excretion, body mass index, healthy children

Kaynakça

• Biyikli NK, Alpay H, Guran T. Hypercalciuria and recurrent uri- nary tract infections: incidence and symptoms in children over 5 years of age. Pediatr Nephrol 2005;20:1435-8.
• Vachvanichsanong P, Malagon M, Moore ES. Urinary tract in- fection in children associated with idiopathic hypercalciuria. Scand J Urol Nephrol 2001;35:112-6.
• Özokutan BH, Küçükaydın M, Gündüz Z, et al. Urolithiasis in childhood. Pediatr Surg Int 2000;16:60-3.
• Milliner DS, Murphy ME. Urolithiasis in pediatric patients Ma- yo Clin Proc 1993;68:241-8
• Moxey-Mims MM, Stapleton FB. Hypercalciuria and nephrocal- cinosis in children. Curr Opin Pediatr 1993;5:186-90.
• Stapleton FB.Idiopatic hypercalciuria: association with isolated hamaturia and risk for urolithiasis in children. The Southwest Pediatric Nephrology Study Group. Kidney Int 1990;37:807-11.
• Sargent JD, Stukel TA, Kresel J. Normal values for random uri- nary calcium to creatinin ratios in infancy. J Pediatr 1993;123:393-7.
• Matos V, Van Melle G, Boulat O et al. Urinary phosphate/cre- atinin, calcium/creatinin and magnesium/creatinin ratios in a healthy pediatric population. J Pediatr 1997;131:252-7.
• Esbjorner E, Jones IL. Urinary calcium excretion in Swedish children. Acta Pediatr 1995;34:156-9.
• Reusz GS, Dobos M, Byrd D et al. Urinary calcium and oxalate excretion in children. Pediatr Nephrol 1995;9:39-44.
• Thomas L. Calcium (Ca). In Clinical Laboratory Diagnosis, Tho- mas L (ed.), TH- Books, 1st ed.,1998, Deighton York, England. p:238.
• Ring E, Borkenstein M. Use of the calcium-creatinine ratio in di- agnosis and therapy. Padiatr Padol, 1987;22:245-50.
• Nuzzo V, Fittipaldi MR, Fonderico F. Urinary calcium excretion in a population of children living in Southern Italy. Minerva Pe- diatr 1999;51:53-6.
• Janda J, Feber J, Sikut M et al. Determination of the calci- um/creatinine index in urine in healthy neonates, infants and children. Cesk Pediatr 1992;47:353-6.
• Alconcher LF, Castro C, Quintana D et al. Urinary calcium exc- retion in healthy school children. Pediatr Nephrol 1997;11:186- 8.
• Ceran O, Akın M, Aktürk Z et al. Normal urinary calcium/cre- atinine ratios in Turkish children. Indian Pediatr 2003;40:884-7.
• Sonmez F, Akcanal B, Altıncık A, Urinary Calcium Excretion in Healthy Turkish Children. Int Urol Nephrol 2006 Oct 17; [Epub ahead of print]
• Henry JB, Lauzon RB, Schumann GB. Causes of hypercal- ciuria. In Clinical Diagnosis and Management by Laboratory Methods, Henry JB (ed.) W.B. Saunders Company, Philadelphia, Pennsylvania, 1996, 19th ed., p.450.
• Mir S, Serdaroğlu E. Quantification of hypercalciuria with the urine calcium osmolality ratio in children. Pediatr Nephrol 2005;20:1562-5.
• Sargent JD, Stukel TA, Kresel J. Normal values for random uri- nary calcium to creatinine ratios in infancy. J Pediatr 1993;123:393-7.
• Vachvanichsanong P, Lebel L, Moore ES. Urinary calcium excre- tion in healthy Thai children. Pediatr Nephrol 2000;14:847-50.
• Bergem G, Cevit O, Toksoy HB et al. Asymptomatic hypercalci- uria: prevalance and metabolic characteristics. Indian J Pediatr 2001;68:315-8.
• Selimoğlu MA, Alp H, Bitlisli H, et al. Urinary calcium excretion of children living in the east region of Turkey. Turk J Pediatr 1998;40:399-404.
• Rath B, Aggarwal MK, Mishra TK et al. Urinary calcium creati- nine ratio and hypercalciuria. Indian Pediatr 1994;31:311-6.
• Khalil NY, Ahmad S, Khan M et al. Population based data on urinary excretion of various metabolites in children of north western region of Pakistan. J Pak Med Assoc 1998;48:241-2.
• Manz F, Kehrt R, Lausen B, Merkel A et al. Urinary calcium exc- retion in healthy children and adolescents. Pediatr Nephrol 1999;13:894-9.
• Sweid HA, Bagga A, Vasvani M et al. Urinary excretion of mi- nerals, oxalate and uric acid in north Indian children. Pediatr Nephrol 1997;11:189-92.
• Juuti M, Heinonen P, Alhava EN. Seasonal variation in urinary excretion of calcium, oxalate, magnesium, and phosphate on free and standard diet in men with urolithiasis. Scan J Urol Nephrol 1981;15:137-41.
• Alkobi L, Boichis H, Orda S. Urinary calcium/creatinine ratio following calcium deprivation and calcium loading in an Isra- eli population. Isr J Med Sci 1985;21:895-7.
• Seifert-McLean CM, Cromer BA, Mosher G et al. Urinary calci- um excretion in healthy adolescents. J Adolesc Health Care 1989;10:300-4.
• Elliott D, Opas LM. Consultation with the specialist: Renal sto- nes. Pediatr Rev 1999;20:280-2.
• Cachat F, Barbey F, Guignard JP. Urinary calculi epidemiology in children. Rev Med Suisse Romande 2004;124:433-7.
• Lavocat MP, Freycon MT, Muchrif M. Comparative study of 24-hour calciuria and urinary calcium/creatinine ratio in child- ren over 4 years of age. Pediatrie 1992;47:565-8.
• Safarinejad MR. Urinary mineral excretion in healthy Iranian children. Pediatr Nephrol 2003;18:140-4.
• Cirillo M, Mellone M, De Santo NG. Can overnight urine repla- ce 24-hour urine collection to measure urinary calcium in epi- demiological studies. Miner Electrolyte Metab 1993;19:385-8.
• Newman DJ, Price Cp. Renal calculi. In Tietz Textbook of Clini- cal Chemistry, Burtis CA, Ashwood ER (eds.), W.B. Saunders Company, Philadelphia, Pennsylvania, 1999, 3rd edition, p.1231-2.
• de Portela ML, Esther Rio M, Zeni S. Urinary calcium/creatinine ratio as an indicator of the nutritional status of calcium. Arch Latinoam Nutr 1983;33:633-41.
• Stapleton FB, Roy S 3rd, Noe HN. Hypercalciuria in children with hematuria. N Engl J Med 1984, 24;310:1345-8.