Edward Nehus, Marion Schulte, Prasad Devarajan, William DeFoor
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引用次数: 0
Abstract
Introduction: Calcium phosphate stones are commonly found in medically complex children (MCC) receiving enteral feeds. The objective of this study is to investigate the etiology for calcium phosphate stones in this patient population.
Study design: This is a retrospective cohort study of gastrostomy fed, MCC who presented to a high-volume Pediatric Stone Center from 2015 to 2019. MCC were defined as those with a diagnosis of cerebral palsy and/or severe developmental delay who were non-ambulatory. A control group was composed of newly presenting patients to the stone clinic without comorbid conditions. Twenty-four hour urine collections were performed prior to medical intervention and were compared between MCC and controls.
Results: Twenty-four MCC children were compared to 38 controls. The median age (interquartile range [IQR]) and weight of MCC were 11.9 (7.5, 16.3) years and 28.6 (21.0, 37.0) kg. Urine supersaturation of calcium phosphate (SSCaP) was similar in MCC and controls (1.7 and 2.0, p = 0.40). Weight-based 24-h urine calcium and phosphorus excretion were also similar in MCC and controls. The median BSA-adjusted urine volume was significantly higher in MCC vs controls (2.2 vs. 1.2 L/1.73 m2, p < 0.001), which contributed to lower 24-h average urinary phosphorus (271.9 vs. 689.7 mg/L, p < 0.001) and calcium concentrations (73.3 vs. 132.8 mg/L, p < 0.001). However, urine pH was significantly higher in MCC (7.4 vs. 6.3, p < 0.001), as was net gastrointestinal absorption of alkali (1.1 vs. 0.3 mEq/kg/day, p < 0.001). In regression analysis, SSCaP increased by a factor of 2.82 for every 1-unit increase in urine pH (p < 0.001).
Conclusion: A high urine pH is associated with an increased risk of calcium phosphate nephrolithiasis in MCC. This may be caused by a higher alkaline content of enteral feeding formulations compared to children on a standard American diet.
期刊介绍：
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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