Association between hypercalciuria and urinary tract infection in children
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261140Keywords:
Children, Hypercalciuria, Pyuria, Spot calcium-to-creatinine ratio, Urinary calcium, Urinary tract infectionAbstract
Background: Urinary tract infection (UTI) is a common bacterial infection in children and a significant cause of morbidity, particularly in infants and young children. Hypercalciuria, a metabolic abnormality characterized by excessive urinary calcium excretion, may predispose children to UTIs by facilitating uroepithelial irritation and bacterial colonization. Understanding the association between hypercalciuria and pediatric UTI can improve diagnosis and management. This study aimed to evaluate the association between hypercalciuria and urinary tract infection in children.
Methods: This case-control study was conducted at the Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, over 18 months from December 2020 to May 2022. Ninety children aged 1-12 years were enrolled, including 45 cases with confirmed UTI and 45 age- and sex-matched healthy controls. Demographic data, urinary biochemical parameters (urinary calcium, creatinine, spot Ca/Cr ratio), and pyuria were assessed. Hypercalciuria was defined by elevated spot urinary calcium-to-creatinine ratio. Statistical analysis was performed using chi-square and independent t-tests, with p<0.05 considered significant.
Results: The mean age of cases and controls was 5.23±3.32 and 5.83±3.32 years, respectively, with a female predominance among cases (60%). Urinary calcium levels (1.35±2.01 mg/dl vs. 0.28±0.17 mg/dl, p=0.001) and spot Ca/Cr ratios (0.068±0.106 vs. 0.015±0.012, p=0.002) were significantly higher in UTI cases compared to controls. Hypercalciuria was present in 44.4% of cases versus 15.6% of controls (p=0.003). Pyuria was markedly elevated in cases, with 75.6% showing >10 pus cells/HPF, compared to 57.8% of controls having nil pus cells (p<0.001). No significant association was observed between hypercalciuria and UTI recurrence (p=0.420).
Conclusions: Pediatric UTIs predominantly affect younger children, especially females and those from rural areas. Hypercalciuria is significantly associated with UTI, independent of recurrence, highlighting the importance of metabolic evaluation in children presenting with UTI. Early detection and management of hypercalciuria may reduce susceptibility to infection and improve long-term outcomes.
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