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Pediatric nephrolithiasis and the link to bone metabolism

Schwaderer, Andrew Lawrencea,b; Kusumi, Kirstena,c; Ayoob, Rose Marya

Current Opinion in Pediatrics: April 2014 - Volume 26 - Issue 2 - p 207–214
doi: 10.1097/MOP.0000000000000069
NEPHROLOGY: Edited by Michel Baum

Purpose of review: To review the recent publications describing the link between pediatric nephrolithiasis and bone metabolism.

Recent findings: Nephrolithiasis incidence is increasing in children and is associated with low bone mineral density (BMD). Affected children are conceptually at risk for fractures and osteoporosis. In addition to abnormal calcium metabolism, inflammation, genetic makeup and dietary habits are being recognized as important factors in the pathophysiology of nephrolithiasis and low bone density. Findings from retrospective reviews suggest that low BMD in children may be improved with citrate or thiazide treatment.

Summary: The healthcare burden from low BMD with subsequent osteoporosis and fracture risk is immense with potential far-reaching effects in patient quality of life and healthcare expense. Bone mass is acquired in the pediatric age range, thus it is important to identify and treat at-risk children. Retrospective reviews in pediatric patients indicate that citrate or thiazide diuretic treatment may improve BMD. We now understand that a relationship exists between nephrolithiasis and low BMD. To improve healthcare for our current patients as well as protect their future health it is important to identify low BMD and initiate strategies to improve BMD in ‘at-risk’ children.

aNationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Division of Nephrology

bThe Research Institute at Nationwide Children's Hospital, Center for Clinical and Translational Medicine

cPediatric Nephrology Fellowship, Nationwide Children's Hospital, Ohio, USA

Correspondence to Andrew Schwaderer, 700 Children's Drive, Columbus, OH 43205, USA. Tel: +1 614 722 4360; fax: +1 614 722 6482; e-mail: Schwaderer.5@osu.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins