兒童之高尿鈣症

血尿雖是兒童尿路系統中常見的症狀之一，但因高尿鈣症所導致的小兒血尿則不多見。本文提出二例高尿鈣症合併血尿之病例；病例一是5歲的男孩，因間歇性肉眼血尿而住院檢查。病例二是7歲的男孩，因有肉眼血尿而住院檢查。該二病例經超音渡，靜脈腎臟攝影，尿鈣排泄橄查後發現；病例1之連續二次空腹時之尿液中Ca/Cr值分別為0.46,0.35。24小時之尿鈣排泄量分別為8.0 mg/kg, 6.9 mg/kg。病例2之連續二次空腹時之尿液中Ca/Cr值分別為0.36, 0.31。24小時之尿鈣排泄量分別為5.1 mg/kg, 6.3 mg/kg。顯示該二病例之尿鈣排泄量均比正常之尿鈣排泄量有明顯的增加。於進一步口服鈣負荷試驗顯示；病例一在口服鈣負荷前之尿鈣排泄量雖正常，但在口服鈣負荷後之尿鈣排泄量卻比正常者於口服鈣負荷後之尿鈣排泄量有明顯的增加，而被診斷為吸收性之高尿鈣症者。病例二則於口服鈣負荷前後均比正常之尿鈣排泄值為高，故被診斷為腎臟性之高尿鈣症者。該二病童經1-2週之低劑量hydrochlorothiazide之治療後病例一之尿液中Ca/Cr值降為0.10, 24小時之尿鈣排泄量降為1.4 mg/kg，病例二之尿液中Ca/Cr值降為0.092, 24小時之尿鈣排泄量降為1.5 mg/kg，其血尿也隨之消失，二病童出院後仍於門診追蹤檢查。

關鍵字

高度鈣；血尿；口服鈣負荷試雖；吸收性高尿鈣；腎臟性高原鈣

並列摘要

Hematuria is a very common disorder of renal or urinary tract in childhood, but it is very rarely caused by hypercalciuria in childhood. Two cases of hypercalciuria with hematuria were experienced in recent years. Case 1, a 5-year-old boy, was hospitalized for evaluation of intermittent gross hematuria. Case 2, a 7year- old boy, was hospitalized for evaluation of gross hematuria. After a series of examinations imcluding IVP, abdominal sonography, urinary calcium excretion, etc. The results shown in case 1; two consecutive fasting urine Ca/Cr were 0.46, 0.35 respectively, and 24-hour urinary calcium excretion were 8.0 mg/kg, 6.9 mgl kg respectively. Under the diagnosis of hypercalciuria, oral calcium-loading test was performed. Before oral calcium-loading test, the urine Ca/Cr was 0.081, and after oral calcium-loading test, the urine Ca/Cr was 0.39. Therefore absorptive hypercalcium was diagnosed. In case 2, two consecutive fasting urine Ca/Cr were 0.36, 0.31 respectively, and 24-hour urinary calcium excretion were 5.1 mg/kg, 6.3 mg/kg respectively. Under the diagnosis of hypercalciuria, oral calcium-loading test was performed. Before oral calcium-loading test, theurine Ca/Cr was 0.36, and after oral calcium-loading test, the urine CalCr was 0.91 respectively. So renal hypercalcium was diagnosed. Small dose of hydrochloroathiazide (0.5-1.0 mg/kg/day)) was given to the two cases. One to two weeks later, the urinary calcium excretion was much decreased, and bloody urine also disappeared in the two cases finally.

並列關鍵字

hypercalciuria ； hematuria ； oral calcium-loading test ； absorptive hypercalciuria ； renal hypercalciuria

國際替代計量

兒童之高尿鈣症

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