Beyond kidney stones: Why pediatricians should worry about hypercalciuria

Abstract

The incidence of urolithiasis (UL) is increasing, and it has become more common in children and adolescents over the past few decades. Hypercalciuria is the leading metabolic risk factor of pediatric UL, and it has high morbidity, with or without lithiasis as hematuria and impairment of bone mass. The reduction in bone mineral density has already been described in pediatric idiopathic hypercalciuria (IH), and the precise mechanisms of bone loss or failure to achieve adequate bone mass gain remain unknown. A current understanding is that hypercalciuria throughout life can be considered a risk of change in bone structure and low bone mass throughout life. However, it is still not entirely known whether hypercalciuria throughout life can compromise the quality of the mass. The peak bone mass is achieved by late adolescence, peaking at the end of the second decade of life. This accumulation should occur without interference in order to achieve the peak of optimal bone mass. The bone mass acquired during childhood and adolescence is a major determinant of adult bone health, and its accumulation should occur without interference. This raises the critical question of whether adult osteoporosis and the risk of fractures are initiated during childhood. Pediatricians should be aware of this pediatric problem and investigate their patients. They should have the knowledge and ability to diagnose and initially manage patients with IH, with or without UL.

Associations between lumbar bone mineral density, serum 25-hydroxyvitamin D and history of kidney stones in adults aged 30–69 years in the USA (NHANES 2011–2018)

“…Therefore, we aimed to determine the relationship between a history of kidney stones and human bone health. As many patients with kidney stones have hypercalciuria, clinicians are concerned that their bone mineral density (BMD) may be reduced, which has inspired several recent studies 5–8. Although many studies have found that the occurrence of kidney stones is associated with a decreased BMD, the results remain inconclusive.…”