[Osteopenia and renal calcification in a 4.5 year old child with primary distal renal tubular acidosis treated for idiopathic renal hypercalciuria].
We present a case of a 4.5 years old boy suffering from hypercalciuria caused by a not diagnosed distal renal tubular acidosis. In the age of 2.5 years, after a banal infection the routine analysis showed a presence of numerous calcium phosphates in urine. Other diagnostic procedures showed: hypercalciuria, hyperphosphaturia, rather high calcemia and high values of UCa/cr and UPO4/cr ratios. HCO3 in serum 21.2 mmol/l, pH of urine 7.0. Kidneys and urinary tract-usg normal. These results induced the family doctor to make the diagnosis: idiopathic renal hypercalciuria. He advised the therapy with hydrochlorothiazide and limitations of calcium and vitamins D3 oral supply. This decision caused an illusory positive effect: decreased the UCa/cr ratio (to 0.96 mmol/mmol) without any reduction of calcemia. After a period of 12 months the UCa/cr ratio increased up to 1.31 and calcification of renal pyramids appeared. We diagnosed the distal renal tubular acidosis (some medical informations suggested the essential distal renal tubular acidosis) and osteopenia (DXA BMD L1-L4 below -1 s.d.). The therapy with NaHCO3 (about 2.6 mmol/kg) normalized the levels of HCO3a and calcium in serum, decreased the UCa/cr ratio to values 0.09-0.16 mmol/mmol.
Kołłataj
W
W
Klinika Pediatrii, Endokrynologii i Neurologii Akademii Medycznej w Lublinie.
Szewczyk
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L
D000141:Acidosis, Renal Tubular / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D001851:Bone Diseases, Metabolic / Q000209:etiology*; D002114:Calcinosis / Q000209:etiology*; D002118:Calcium / Q000652:urine*; D002675:Child, Preschool; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D017693:Sodium Bicarbonate / Q000627:therapeutic use
D017693:Sodium Bicarbonate; D002118:Calcium