Hypercalciuria in osteogenesis imperfecta: a follow-up study to assess renal effects.
In 1991, we reported that hypercalciuria is a common finding in our pediatric patient population with osteogenesis imperfecta (OI) (17 of 47 = 36%). Here, we prospectively screened 12 of these hypercalciuric children, on average 4 years subsequent to the discovery of elevated urine calcium levels, for adverse effects on renal function. Despite an ad libitum decrease since initial investigation of about 30% in their previously normal dietary calcium intake (adjusted for body weight), 8 of the 12 patients remained hypercalciuric (urine calcium/creatinine > 0.62 mmol/mmol). We found, once again, that urinary calcium levels significantly correlated with the severity of the skeletal disease as assessed by z-score for height (r = -0.75, p = 0.005). Evaluation of kidney function, however, revealed: (i) normal routine urinalysis in all but 1 subject who had transient microscopic hematuria; (ii) unremarkable concentrating ability determined by fasting urine osmolality; (iii) normal creatinine clearance, and (iv) unremarkable ultrasonography to measure renal size and to screen for nephrocalcinosis or nephrolithiasis. Although no significant renal compromise was detected with these studies in our hypercalciuric pediatric OI patients, investigation of affected adults, especially those severely affected, will be important to assess whether this is a long-term problem and if adverse effects on the kidneys do develop.