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      Urine risk factors in children with calcium kidney stones and their siblings

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          Abstract

          Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone forming children, we compared chemical measurements and the crystallization properties of 24-hour urine collections from 129 stone formers matched to 105 non-stone forming siblings and 183 normal, healthy children with no family history of stones; all aged 6 to 17 years. The principal risk factor for calcium stone formation was hypercalciuria. Stone formers have strikingly higher calcium excretion along with high supersaturation for calcium oxalate and calcium phosphate, and a reduced distance between the upper limit of metastability and supersaturation for calcium phosphate, indicating increased risk of calcium phosphate crystallization. Other differences in urine chemistry that exist between adult stone formers and normal individuals such as hyperoxaluria, hypocitraturia, abnormal urine pH and low urine volume were not found in these children. Hence, hypercalciuria and a reduction in the gap between calcium phosphate upper limit of metastability and supersaturation are crucial determinants of stone risk. This highlights the importance of managing hypercalciuria in children with calcium stones.

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          Physiopathology and etiology of stone formation in the kidney and the urinary tract

          All stones share similar presenting symptoms, and urine supersaturation with respect to the mineral phase of the stone is essential for stone formation. However, recent studies using papillary biopsies of stone formers have provided a view of the histology of renal crystal deposition which suggests that the early sequence of events leading to stone formation differs greatly, depending on the type of stone and on the urine chemistry leading to supersaturation. Three general pathways for kidney stone formation are seen: (1) stones fixed to the surface of a renal papilla at sites of interstitial apatite plaque (termed Randall’s plaque), as seen in idiopathic calcium oxalate stone formers; (2) stones attached to plugs protruding from the openings of ducts of Bellini, as seen in hyperoxaluria and distal tubular acidosis; and (3) stones forming in free solution in the renal collection system, as in cystinuria. The presence of hydroxyapatite crystals in either the interstitial or tubule compartment (and sometimes both) of the renal medulla in stone formers is the rule and has implications for the initial steps of stone formation and the potential for renal injury.
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            Clinical practice. Calcium kidney stones.

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              EQUIL2: a BASIC computer program for the calculation of urinary saturation.

              A BASIC computer program for the calculation of urinary supersaturation with respect to the common kidney stone components is described. In vitro and in vivo tests show that the program described accurately calculates supersaturation. The application of this computer program to urolithiasis research is discussed.
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                Author and article information

                Journal
                0323470
                5428
                Kidney Int
                Kidney Int.
                Kidney International
                0085-2538
                1523-1755
                9 February 2012
                22 February 2012
                June 2012
                01 December 2012
                : 81
                : 11
                : 1140-1148
                Affiliations
                [1 ]Department of Medicine, Nephrology Section, University of Chicago, Chicago, IL
                [2 ]Division of Urology, Albany Medical Center and Urological Institute of Northeastern New York, Albany, NY
                [3 ]Division of Pediatric Urology, Nemours Children’s Clinic, Jacksonville, FL
                [4 ]Division of Pediatric Urology, Cincinnati Children’s Hospital, Cincinnati, OH
                [5 ]Department of Pediatrics, Division of Nephrology, The Ohio State University College of Medicine, Columbus, OH
                [6 ]Litholink Corporation, Chicago, IL
                Author notes
                Correspondence to: Kristin Bergsland, The University of Chicago, Section of Nephrology/MC5100, 5841 S. Maryland Ave. Chicago, IL 60637, (773) 702-2871 – Phone, (773) 702-5818 – Fax, kbergsland@ 123456.uchicago.edu
                Article
                NIHMS352848
                10.1038/ki.2012.7
                3353022
                22358148
                ca475b6c-f69c-467f-bf90-b2a05cafec9e
                History
                Funding
                Funded by: National Institute of Diabetes and Digestive and Kidney Diseases : NIDDK
                Award ID: R44 DK071375-03 || DK
                Categories
                Article

                Nephrology
                kidney calculi,hypercalciuria,calcium oxalate
                Nephrology
                kidney calculi, hypercalciuria, calcium oxalate

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