Idiopathic hyperuricosuria, hypercalciuria and infantile renal stone disease: new association and therapeutic approach

Aamir Jalal Al-Mosawi

Background: Urolithiasis in association with idiopathic hypercalciuria (IHC) plus idiopathic hyperuricosuria (IHU) has been reported in older children and adult patients only. IHU plus IHC in association with progressive infantile bilateral renal stone disease has not been previously reported during the first year of life. Aim: The aim of this paper is to report the novel association of IHU, IHC and progressive infantile bilateral renal stone disease and also to report our therapeutic approach for this new association, combining traditional treatments of hyperuricosuria (HU) and hypercalciuria (HC) with recently used essential oil terpenes in the management of childhood and infantile urolithiasis. Patients & methods: An 8.5-month old boy was referred with bilateral multiple stone disease. He initially presented with excessive crying and irritability since early infancy. The first renal stone was detected using ultrasound and intravenous pyelogram (IVP) at the age of 4 months. On referral, he showed signs of colic with excessive crying. Renal ultrasound showed bilateral multiple stones. 24-h urine examination revealed concomitant significant HU (1.7 g/day) and HC (15 mg/kg/day). 24-h urine oxalate excretion was also mildly elevated (2.9 mg/kg/day). Due to the serious nature of infantile progressive stone disease, the boy was treated with triple therapy consisting of hypocalciuric diuretics, allopurinol and essential oil terpenes with the aim of achieving a stone-free state and preventing renal damage. Results: Early symptomatic relief was achieved during the first week of therapy. A stone-free state was achieved after 3 months of treatment without the occurrence of any side effects. Discussion & conclusion: IHC and IHU have rarely been association with progressive infantile bilateral renal stone disease. Therapy for this new association with a combination of the traditional treatments of HU and HC with essential oil terpenes may be beneficial.