Abstract
Hematuria is one of the most common urinary abnormalities found in children. When hypercalciuria was identified as a potential etiology of painless hematuria, many questions arose concerning the general importance of this observation. Subsequently, increased uric acid excretion also has been purported to cause hematuria in children. This review traces the history of these observations and describes the clinical characteristics of the clinical syndrome of hematuria associated with hypercalciuria and hyperuricosuria. Diagnostic criteria of excessive urinary excretion of calcium and uric acid are reviewed; differences in urinary calcium and uric acid excretion between infants and older children are emphasized. Aside from urolithiasis, few long-term consequences from hypercalciuria or hyperurcosuria have been identified, although some debate exists concerning the effect of chronic hypercalciuria upon bone mineralization.
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West CD (1976) Asymptomatic hematuria and proteinuria in children: causes and appropriate diagnostic studies. J Pediatr 89: 173–182
Wyatt RJ, McRoberts JW, Holland NH (1977) Hematuria in childhood: significance and management. J Urol 117:366–368
Iitaki K, West CD (1978) The renal calculus and asymptomatic hematuria. J Pediatr 92:774–776
Moore ES (1981) Hypercalciuria in children. Contrib Nephrol 27:20
Kalia A, Travis LB, Brouhard BH (1981) The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr 99:716–719
Roy S III, Stapleton FB, Noe HN, Jerkins G (1981) Hematuria preceding renal calculus formation in children with hypercalciuria. J Pediatr 99:712–715
Perrone HC, Aizen H, Toporovski J, Schor N (1991) Metabolic disturbance as a cause of recurrent hematuria in children. Kidney Int 39:807–811
Sanchez BM, Ramo MC (1989) Hyperuricosuria and microhematuria in childhood. Am J Dis Child 143:878–879
Stapleton FB, Roy S, Noe HN, Jerkins G (1984) Hypercalciuria in children with hematuria. N Engl J Med 310:1345–1348
Cervera A, Corral MJ, Gomez Gampder FJ, deLecca AM, Luque A, Gomez JML (1987) Idiopathic hypercalciuria in children: classification, clinical manifestations and outcome. Acta Pediatr Scand 76:271–278
Stapleton FB (1990) Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children. The Southwest Pediatric Nephrology Study Group. Kidney Int 37: 807–811
Hisano S, Kwano M, Hatae K, Kaku Y, Yamane I, Ueda K, Uragoh K, Houda S (1991) Asymptomatic isolated microhematuria: natural history of 136 children. Pediatr Nephrol 5:578–581
Alon U, Warady BA, Hellerstein S (1990) Hypercalciuria in the frequency-dysuria syndrome of childhood. J Pediatr 116:103–105
Favish B (1990) Irritability and dysuria in infants with idiopathic hypercalciuria. Pediatr Nephrol 110:262–264
Malone JI, Lowitt S, Duncan JA, Shah SC (1987) Hematuria and hypercalciuria in children with diabetes mellitus. Pediatrics 79: 756–759
Springate JE, Fildes RD, Mauer SM, Feld LG (1986) Hematuria and hypercalciuria following renal transplantation. Transplantation 41:664–665
Stapleton FB, Hanissian AS, Miller LA (1985) Hypercalciuria in children with juveile rheumatoid arthritis: association with hematuria. J Pediatr 107:235–239
Grossman H, Duggan E, McCamman S, Werchert E (1980) The dietary chloride deficiency syndrome. Pediatrics 66:366–374
Wilson RJ (1969) Renal excretion of calcium and sodium in acute nephritis. BMJ 4:713–715
Bonilla-Felix M, Villegas-Medina O, Vehaskari M (1994) Renal acidification in children with idiopathic hypercalciuria. J Pediatr 124:529–534
Voghenzi A, Bezzi TM, Luscardi P, Soriani S (1992) Acquired hyperoxaluria and haematuria in children. Pediatr Nephrol 6: 356–357
Welch TK, Shely E (1988) Experimental hypercalciuria does not affect urinary red blood cell excretion. Pediatr Res 23:549A
Lawoyin S, Sismilieh S, Browne R, Pak CYC (1979) Bone mineral content in patients with primary hyperparathyroidism, osteoporosis, and calcium urolithiasis. Metabolism 28:1250–1254
Stapleton FB, Noe HN, Jerkins GR, Roy S III (1982) Hypercalciuria in children with urolithiasis. Am J Dis Child 136: 675–678
Stapleton FB, Noe HN, Jerkins GR, Roy S III (1982) Urinary excretion of calcium following an oral calcium loading test in healthy children. Pediatrics 69:594–597
Pak CYC, Britton F, Peterson R, Ward D, Breslau NA, McGuire J, Sakahee K, Bush S, Nicar M, Norman DA, Peter P (1980) Ambulatory evaluation of nephrolithiasis: classification, clinical presentation, and diagnostic criteria. Am J Med 69:19–28
Coe FL, Favus MJ, Crockett T, Strauss AL, Parks JH, Porat H, Gantt CL, Sherwood LM (1982) Effects of low calcium diet on urine calcium excretion, parathyroid hormone function and serum 1,25 (OH)2 vitamin D3 levels in patients with idiopathic hypercalciuria. Am J Med 72:25–32
Muldowney FP, Freany P, Moloney MF (1982) Importance of dietary sodium in the hypercalciuric syndrome. Kidney Int 22: 292–296
Natovitz J, Miller LA, Stapleton FB (1992) Dietary sodium and the diagnosis of hypercalciuria. American Pediatric Society and the Society for Pediatric Research Annual Meeting. Pediatr Res 31:331A
Pak CYC (1990) Hypercalciuric calcium nephrolithiasis. In: Resnick MI, Pak CYC (eds) Urolithiasis: a medical and surgical reference. Saunders, Philadelphia, pp 45–49
Baldree LA, Stapleton FB (1990) Uric acid metabolism in children. Pediatr Clin North Am 2:391–418
Benjamin D, Sperling O, Weinberger A (1977) Familial hypouricemia due to isolated renal tubular defect. Attenuated response of uric acid to probenecid and pyrazinamide. Nephron 18:220–225
Beck LH (1979) Hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone. N Engl J Med 301:528–530
Padova J, Patchefsky A, Onesti G (1964) The effect of glucose loads on renal uric acid excretion in diabetic patients. Metabolism 28:472–476
Chen YH, Lee AJ, Chen CH, Chesney RW, Stapleton FB, Roy S III (1994) Urinary mineral excretion among Taiwanese children. Pediatr Nephrol 8:36–40
DeSanto NG, DiLorico B, Capasso G, Paduano C, Stamler R, Langman CB, Stamler J (1992) Population based data on urinary excretion of calcium, oxalate, phosphate and uric acid in children from Cimitile. Pediatr Nephrol 6:149–157
Ghazali S, Barratt TM (1974) Urinary excretion of calcium and magnesium in children. Arch Dis Child 45:97
Kruse K, Kracht U, Kruse U (1984) Reference values for urinary calcium excretion and screening for hypercalciuria in children and adolescents. Eur J Pediatr 143:25–31
Langman CB, Moore ES (1984) Hypercalciuria in clinical pediatrics: a review. Clin Pediatr (Phila) 23:135–137
Sargent JD, Stukel TA, Kresel J, Klein RZ (1993) Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr 123:393–397
Hillman LS, Chow W, Salmon SS, Weaver E, Erikson M, Hansen J (1988) Vitamin D metabolism, mineral homeostasis and bone mineralization in term infants fed human milk, cow milk-based formula or soy-based formula. J Pediatr 112:864–874
Karlen J, Aperia A, Zetterstrom R (1985) Renal excretion of calcium and phosphate in preterm and term infants. J Pediatr 106: 814–818
Rowe JD, Goetz CA, Carey DE, Horek E (1987) Achievement of in utero retention of calcium and phosphorus accompanied by high calcium excretion in VLBW infants fed a fortified formula. J Pediatr 110:581–585
Stapleton FB, Linshaw MA, Hassanein K (1978) Uric acid excretion in normal children. J Pediatr 92:911–914
Stapleton FB, Nash D (1983) A screening test for hyperuricosuria. J Pediatr 102:88–90
Stapleton FB (1983) Renal uric acid clearance in human neonates. J Pediatr 103:290–294
Pizzarelli F, Ciccarelli C, Maggiore Q (1984) Transient hypercalciuria during acute pyelonephritis and active stone formation. In: Schwille PO, Smith LH, Robertson WG, Vatilensieck W (eds) Urolithiasis and related clinical research. Plenum, New York, pp 387–390
Garcia CD, Miller LA, Stapleton FB (1991) Natural history of hematuria associated with hypercalciuria in children. Am J Dis Child 145:1204–1207
Stapleton FB, Jones DP, Miller LA (1989) Evaluation of bone metabolism in children with hypercalciuria. Semin Nephrol 9: 75–78
Langman CB (1994) Children with genetic hypercalciuria exhibit thiazide-responsive osteopenia. Pediatr Res 35:368A
Buckalew VM Jr, Purvis ML, Shelman MB (1974) Hereditary renal tubular acidosis. Medicine (Baltimore) 53:229–254
Reusz GS, Tulassay T, Szabo A, Milteny M (1987) Effects of thiazide on urinary calcium excretion and hematuria in children with post-glomerular hematoma. Int J Pediatr Nephrol 8:147–151
Miller LA, Stapleton FB (1985) Urinary citrate excretion in children with hypercalciuria. J Pediatr 107:263–266
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Stapleton, F.B. Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach. Pediatr Nephrol 8, 756–761 (1994). https://doi.org/10.1007/BF00869114
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DOI: https://doi.org/10.1007/BF00869114