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      Comparison of urinary sodium and potassium in children older than two with idiopathic hypercalciuria and a healthy control group in Bandar-Abbas, Iran, in 2013

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          Abstract

          Background:

          Idiopathic hypercalciuria is an important cause of symptoms related to the urinary system. The urinary excretion of high sodium and low potassium is a risk factor for hypercalciuria and urolithiasis. The aim of this study was to compare the urinary excretion of sodium and potassium by children older than two with idiopathic hypercalciuria and healthy control children in Bandar-Abbas, Iran.

          Methods:

          This case control study was conducted during 2012 and 2013 in Bandar-Abbas, a city in southern Iran. The urinary excretion of sodium and potassium by 50 children with idiopathic hypercalciuria who were older than two was compared with that of 62 healthy children. IBM SPSS Statistics 21 software was used to analyze the data, and P < 0.05 was considered to be significant.

          Results:

          Fifty children with idiopathic hypercalciuria (21 males and 29 females) were compared with 62 healthy children (19 males and 43 females). The results of the study indicated that there were no significant differences in the mean sodium and potassium levels in the urine of the two groups of children (P = 0.401 and P = 0.479, respectively.)

          Conclusion:

          The study showed no significant differences in the excretion of sodium and potassium in the urine of children with idiopathic hypercalciuria and that of healthy children in Bandar-Abbas. This finding was inconsistent with the results of similar studies conducted earlier. Therefore, more studies are needed on populations in different areas with various climates and difference races.

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          Most cited references18

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          The nature and significance of the relationship between urinary sodium and urinary calcium in women.

          A G Need, B Nordin, Alan H Morris … (1993)
          Orally or parenterally administered sodium is known to increase urinary calcium in experimental animals and humans, and there is well-documented correlation between urinary sodium and calcium in 24-h urine collections from normal subjects and renal stone formers. The correlation between urinary sodium and calcium is generally sodium driven, i.e., it is the sodium load that influences urinary calcium rather than vice versa, but the converse may also occur, as after an oral calcium load or in hypercalcemia. When sodium is the determinant, 100 mmol of sodium takes out approximately 1 mmol of calcium in the urine. When calcium load is the determinant, each millimole of calcium appearing in the urine is associated with an extra 10-20 mmol of sodium. Sodium-dependent calcium loss may continue indefinitely, but calcium-dependent natriuresis is self-limiting. There is a significant correlation between calcium and sodium in fasting urine from both pre- and postmenopausal women, but there is more calcium relative to sodium in postmenopausal women than in premenopausal women. In postmenopausal but not premenopausal women, urinary hydroxyproline is also related to obligatory sodium and calcium output, and restriction of salt intake lowers not only urinary sodium but also calcium and hydroxyproline. There is not only an increase in obligatory calcium excretion at the menopause, but also an increase in the fasting urinary sodium, which in turn accounts for some of the increase in calcium output. This rise in fasting urinary sodium represents a delay in sodium excretion that may have a significant effect on calcium homeostasis.
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            The relationship between urinary calcium, sodium, and potassium excretion and the role of potassium in treating idiopathic hypercalciuria.

            Ana Luiza A. R. Osório, U Alon (1997)
            1) To evaluate the relationships between urinary sodium (UNa), potassium (UK), and calcium (UCa) excretion in the pediatric population; and 2) to determine the effect of increasing potassium intake in patients with idiopathic hypercalciuria and investigate whether this intervention can be offered as another mode of therapy in this patient population. Prospectively, we determined UNa, UK, UCa, and creatinine (Cr) concentrations in randomly collected urine samples from children on initial evaluation for urinary frequency, dysuria, hematuria, enuresis, or kidney stones to identify children with hypercalciuria. The outpatient renal clinic of an academic hospital. Twenty-three black children (13 girls and 10 boys) and 77 white children (44 girls and 33 boys) 3.92 to 16.67 years of age. Eleven children with hypercalciuria were given potassium supplementation or placed on a high-potassium diet for at least 2 weeks. UNa to UK, UNa to Cr, UK to Cr, and UCa to Cr ratios were calculated from measured levels of urinary minerals. These were repeated in 11 hypercalciuric patients after 2 weeks of increased potassium intake. A total of 100 urine samples were analyzed. The UCa/Cr ratio in blacks 0.04 +/- 0.06 (mean +/- standard deviation) was significantly lower than in whites 0.16 +/- 0.12. There were 21 hypercalciuric white children versus only 1 black child. Linear regression analysis revealed a positive direct correlation between UNa/Cr and UCa/Cr in all 100 subjects and in whites alone but not in blacks. An inverse relationship existed between UK/Cr and UCa/Cr in all subjects and in whites and showed a strong trend in blacks. A marked direct relationship was found between UNa/K and UCa/Cr in all subjects (r = .43) as well as in whites (r = .59) and blacks (r = .49). One black child and 10 white hypercalciuric children were treated with "extra" K for at least 2 weeks. The UNa/K decreased from 4.73 +/- 2.28 to 1.98 +/- 1.09, and the UCa/Cr decreased from 0. 31 +/- 0.10 to 0.14 +/- 0.07, with resolution or improvement of the patients' symptoms. In our patient population with urinary symptoms, the UCa/Cr ratio in black children is lower and hypercalciuria less common than in white children. In both white and black populations, the UNa/K ratio had the strongest association with the UCa/Cr ratio, indicating an opposing role of UNa and UK on the UCa/Cr ratio. Increased potassium intake was found to be beneficial for hypercalciuric children by decreasing the UNa/K ratio and, consequently, the UCa/Cr ratio.
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              Urinary calcium excretion in healthy children and adolescents.

              B Lausen, Peter Merkel, F Manz … (1999)
              Urinary calcium (Ca) excretion was determined in 1,578 24-h urine samples from 507 healthy children and adolescents (252 boys, 255 girls; 2.8-18.4 years) participating in the DONALD Study and is presented for 32 different age and sex groups. Calciuria values related to body weight (mg/kg per day) were relatively constant except for a transient decrease during puberty in all centiles, with a later onset in boys than girls. Distribution of calciuria (mg/kg per day) was best normalized by log transformation, with an almost constant standard deviation of the log-transformed values. Ca excretion was >/=4 mg/kg per day in 8.6% and >/=6 mg/kg per day in 1. 5% of the urine samples. Based on Ca excretion rates of 1,080 pairs of 24-h urine samples from 364 children and adolescents, sensitivity, specificity, and the predictive value for hypercalciuria (>/=4 mg/kg per day) in the next urine sample were calculated at three test levels classifying calciuria of the initial urine sample. In summary, this study presents normal values of urinary Ca excretion related to age and sex in a population of healthy German children and adolescents consuming a typical western-style diet. A high level of calciuria in a random urine sample is important in the diagnosis of hypercalciuria.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electron Physician
                Journal ID (iso-abbrev): Electron Physician
                Journal ID (publisher-id): Electronic physician
                Title: Electronic Physician
                Publisher: Electronic physician
                ISSN (Electronic): 2008-5842
                Publication date Collection: Jul-Sep 2014
                Publication date (Electronic): 01 July 2014
                Volume: 6
                Issue: 3
                Pages: 872-876
                Affiliations
                [1. ] Pediatric diseases resident, Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
                [2. ] Pediatric nephrologist, Department of Pediatrics Nephrology, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
                [3. ] Specialist in pediatric diseases, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
                Author notes
                Corresponding Author: Dr Maryam Esteghamati, Pediatric nephrologist, Department of Pediatrics Nephrology, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tel: +98.9123866020, Fax: +98.07613337192, Email: maryamesteghamati@ 123456yahoo.com
                Article
                Publisher ID: 872-876
                DOI: 10.14661/2014.872-876
                PMC ID: 4324298
                PubMed ID: 25763161
                SO-VID: cf1fd376-8543-47f9-a4fe-afbfafdb0c2e
                Copyright © © 2014 The Authors
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 20 May 2014
                Date revision received : 18 June 2014
                Date accepted : 22 June 2014
                Categories
                Subject: Articles

                Keywords: idiopathic hypercalciuria,urine,sodium,potassium
                Data availability:
                Keywords: idiopathic hypercalciuria, urine, sodium, potassium

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