ÇOCUKLUK ÇAĞINDA NEFROKALSİNOZİS SAPTANAN HASTALARIN KLİNİK ÖZELLİKLERİNİN ARAŞTIRILMASI

Abstract

Yavuz, R.G. Investigation of clinical characteristics of patients diagnosed with nephrocalcinosis in childhood, Hacettepe University Faculty of Medicine, Department of Pediatrics, Thesis in Pediatrics, Ankara, 2024. There are few studies on renal function status and affecting risk factors in the follow-up of patients with nephrocalcinosis in childhood. Our aim is to understand which etiological factor is effective in patients with nephrocalcinosis and to examine kidney survival and affecting factors. In the study, the clinical characteristics of patients who were admitted to Hacettepe University İhsan Doğramacı Children's Hospital between January 2013 and January 2023 and were detected to have nephrocalcinosis in at least two US images were retrospectively examined. The age at diagnosis of 106 patients was 2,4(IQR; 0,5-5,8) years, and the average follow-up period was 5,3±3,1 years. Patients were most often diagnosed incidentally (56,6%). The most common US finding was bilateral medullary nephrocalcinosis in 95,3%. The most common risk factor was hypercalciuria in 25,5%. At the last visit, nephrocalcinosis had improved in 8,5% of patients, 3,8% had improvement at one year, and 56% had no improvement. Patients with recovered nephrocalcinosis at last visit had lower urine density (p=0,02), spot urine calcium/creatinine ratio (p=0,021), 24 hr-urine calcium/creatine ratio (p=0,031) and higher 24-hr urinary citrate (p=0,036) at diagnosis. During follow-up, eGFR change increased by 8,7% (±39,1) in all patients, decreased by 28,5% (±15,9) in those who developed chronic kidney disease, and no patient developed end-stage renal disease. While there was a borderline significant difference in eGFR change with history of diuretic use (p=0,048), no difference was found with vitamin D use (p=0,055). Nephrocalcinosis may progress to chronic kidney disease, and continued follow-up and treatment in nephrology outpatient clinics is required. Low calcium excretion and citrate at the time of diagnosis may be determinants of recovery.

Key words: Nephrocalcinosis, hypercalciuria, hypocitraturia, hyperoxaluria