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Pediatr Nephrol (2014) 29:20652067 DOI 10.1007/s00467-014-2925-1
EDITORIAL COMMENTARY
Urinary excretion of calcium, magnesium, phosphate, citrate, oxalate, and uric acid by healthy schoolchildrenusing a 12-h collection protocol
Bernd Hoppe
Received: 13 June 2014 /Revised: 17 July 2014 /Accepted: 21 July 2014 /Published online: 31 August 2014 # IPNA 2014
Abstract Although we do not have reliable data for the true prevalence of urolithiasis during childhood, the number of patients seen in outpatient clinics and admitted for stone-related problems is steadily increasing worldwide. As for most pediatric patients a metabolic disease is the reason for stone development, because a high number of patients have severely recurrent urolithiasis, early and proper diagnostic evaluation is necessary to begin adequate and preventive treatment. However, diagnostic evaluation, especially in infants and younger children, is not always easy, and frequently a diagnosis is made late. Diagnostic evaluation should start with repeated urine analysis; but how and which urine should be collected and analyzed? What is the best and most accurate method for urine collection? In a paper published in a recent issue of Pediatric Nephrology, Torres and colleagues describe a more simplified method of urine collection. They propose analysis of late-afternoon spot-urine samples as well as an overnight collection of urine as the most appropriate to evaluate patient-specific urinary risk factors. Is this truly the case?
Keywords Renal transplantation . Pediatric . Renal mass
All children with a first kidney stone or the diagnosis of nephrocalcinosis should be screened for metabolic reasons for stone disease in order to start preventive measures as soon as possible [1, 2]. However, what is the best way to collect adequate urine sample(s) first to gain normal age-related values, and secondly to obtain adequate diagnostic information? Only if the normative data depict a true normal and not
an artificial situation of life, are they ready for use. This also applies to urine collected for diagnostic purposes. THE REAL LIFE risk factor for stone disease has to be evaluatedand this can sometimes be problematic!
There are many pitfalls to observe: how can we exclude environmental influences, like dietary excess or extreme fluid intake just at the time of collection? How can we avoid missed portions of a 24-h urine sample in a small child? Is it reliable if...