Hypercalciuria in Children: Causes, Diagnosis, and Treatment

Hypercalciuria

Hello Dr.
Pei: I have two questions to ask you...
(1) My eldest child is currently over four years old, and my second child is over one year old.
I previously asked you about whether these two children have been tested for kidney stones (caused by melamine).
When the urine test results came back, both children had elevated calcium levels in their urine.
My eldest child underwent further ultrasound examination, which showed no kidney stones and normal kidney development.
The pediatrician inquired if we were supplementing with high-calcium foods, to which I confirmed that both children eat porridge made with fish broth (but that is all).
The doctor concluded that the high calcium levels in their urine were due to dietary influences, so no further ultrasound was arranged for my second child.
However, I recently heard about a condition called hypercalciuria, and I would like to ask Dr.
Pei how to determine if someone has hypercalciuria? Could my two children have this condition? Do they need further testing? Additionally, what are the effects of this condition on the body, and how is it treated? (2) During my pregnancy with my second child, I underwent a prenatal screening called a detailed ultrasound, during which a small white spot was noted in the fetal heart area.
The doctor mentioned it could be a calcification or something similar, which might resolve as the child grows, and that follow-up would be needed.
However, since then, no follow-up examinations have been conducted, and the child has been fine.
Recently, I recalled this issue and have been somewhat concerned.
I would like to ask the doctor what that white spot could have been? Should I be worried about it? Is a cardiac ultrasound necessary? I have written so much, and I hope the doctor is not overwhelmed.
Thank you very much for your response...

Xiao Fen, 30~39 year old female. Ask Date: 2008/12/27

Dr. Pei Rensheng reply Pediatrics

Dear Xiaofen,
(1) The diagnostic criteria for hypercalciuria are a 24-hour urinary calcium excretion exceeding 4 mg/kg/day.
However, collecting 24-hour urine can be challenging, so most physicians use a spot urine calcium-to-creatinine ratio (Ca/Cre) as a substitute.
If the ratio is greater than 0.8 for infants under six months, greater than 0.6 for those aged 6 to 12 months, and greater than 0.2 for children over 24 months, it is considered hypercalciuria.
The majority of cases are due to excessive dietary calcium, while a minority are due to metabolic disorders leading to excessive urinary calcium excretion.
It may be helpful to try a low-calcium diet initially and then retest the urine.
Prolonged hypercalciuria can potentially lead to hematuria, urinary stones, or even renal failure.
In addition to dietary management, diuretics can also be beneficial for hypercalciuria.
(2) During a detailed ultrasound examination in pregnancy, a small white spot was observed in the fetal heart, which may indicate calcification.
Calcification points in the fetal heart are often detected during prenatal ultrasound, appearing as bright white spots in the heart muscle.
Sometimes there is one, but it is also common to see two or more.
Some past reports suggested that the presence of calcification points in the fetal heart increases the likelihood of Down syndrome by four times.
However, as clinical experience has grown, this assertion has come under scrutiny.
A study published in June 2005 by the American College of Obstetricians and Gynecologists analyzed 10,875 fetuses, finding that 176 had calcification points in the fetal heart.
The statistics indicated that these calcification points are a normal variation and do not increase the risk of chromosomal abnormalities in the fetus.
If the newborn's health check and vaccinations show no abnormalities, there should be no major concerns; however, if you are still worried, it would be advisable to conduct a follow-up echocardiogram.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Rensheng
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2008/12/27

More Info

Hypercalciuria in children refers to the condition where there is an excessive amount of calcium in the urine. This can be a significant concern as it may lead to the formation of kidney stones or indicate underlying metabolic disorders. Understanding the causes, diagnosis, and treatment of hypercalciuria is essential for managing your children's health effectively.

Causes of Hypercalciuria
Hypercalciuria can arise from various factors, including dietary influences, metabolic disorders, and genetic predispositions. In your case, the pediatrician suggested that the high calcium levels in your children's urine might be related to their diet, particularly if they consume calcium-rich foods. Foods such as dairy products, certain fish, and fortified cereals can contribute to elevated calcium levels in the urine.

Other potential causes of hypercalciuria include:
1. Primary Hyperparathyroidism: An overproduction of parathyroid hormone can lead to increased calcium absorption from the bones and intestines.

2. Familial Hypercalciuria: A genetic condition where family members may have a history of high urinary calcium levels.

3. Renal Tubular Acidosis: A condition where the kidneys fail to adequately excrete acids into the urine, leading to a buildup of acid in the blood and potentially affecting calcium levels.

4. Dehydration: Insufficient fluid intake can concentrate urine and increase calcium levels.

Diagnosis
To diagnose hypercalciuria, a healthcare provider typically conducts a 24-hour urine collection test to measure the amount of calcium excreted. If the calcium levels are found to be elevated, further investigations may be warranted to rule out underlying conditions. Blood tests may also be performed to check calcium, parathyroid hormone, and vitamin D levels.

Treatment
The treatment for hypercalciuria largely depends on the underlying cause. If dietary factors are contributing to the condition, dietary modifications may be recommended. This could involve reducing the intake of high-calcium foods or ensuring adequate hydration to dilute the urine.
In cases where hypercalciuria is due to metabolic disorders, specific treatments may be necessary. For instance, if primary hyperparathyroidism is diagnosed, surgical intervention may be required. In some cases, medications that help manage calcium levels may be prescribed.

Monitoring and Follow-Up
Given that your older child has already undergone an ultrasound and no kidney stones were found, it may not be necessary to pursue further invasive testing unless symptoms develop or calcium levels remain consistently high. Regular follow-up with a pediatrician or a pediatric nephrologist is advisable to monitor urinary calcium levels and kidney function.

Regarding the Heart Condition
As for the white spot observed during the prenatal ultrasound, it is often referred to as a "calcium deposit" or "echogenic focus." These findings are relatively common and, in many cases, are benign and resolve as the child grows. However, if there are concerns or if the child exhibits any symptoms, a follow-up echocardiogram can provide reassurance and ensure that there are no underlying heart issues.

Conclusion
In summary, hypercalciuria can be influenced by dietary habits and may not always indicate a serious condition. Regular monitoring and consultation with healthcare professionals are key to managing your children's health. If you have concerns about their urinary calcium levels or the prenatal findings, it is best to discuss these with your pediatrician, who can provide personalized advice and recommendations based on your children's specific health needs.

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