Evaluation of the Relationship of Hypertension in Pediatric Stone Patients
Casey A. Seideman, MD, Louis Nikolis, MD, Pamela Singer, MD, Nataliya Chorny, MD, Jordan Gitlin, MD, Lane Palmer, MD, Rachel Frank, MD, Lulette Infante, NP, Christine B. Sethna, MD.
Long Island Jewish - Cohen's Children's Medical Center, Lake Success, NY, USA.
Recent studies have demonstrated an independent association between hypertension and urolithiasis in adults. Additionally, urine calcium levels are directly correlated with blood pressure (BP). There is little known about the relationship between BP and urolithiasis in the pediatric population. We sought to evaluate the relationship between BP, urolithiasis and urine electrolytes in children.
We retrospectively analyzed data from children <18 years with urolithiasis from 2004-2015 at a single tertiary center. Stone formers were compared to children diagnosed with non-glomerular hematuria without history of kidney stones or abnormal 24-hr urines. Casual BP, BP index (BPi), and 24-hr urine electrolytes were compared between groups using t-tests. Multiple regression analyses adjusting for age, sex and BMI z-score evaluated the association of BP with urolithiasis and urine electrolytes.
The urolithiasis group (N=71) (11.2±4.1 years, 48% male) was significantly older (p=0.005), taller (p=0.035) and heavier (p=0.005) compared to the non-stone former group (N=53) (9.2±3.5 years, 64% male), however, BMI z-scores were not significantly different (p=0.78). Systolic BP in stone formers (109.4±14.7 mmHg) was significantly greater compared to non-stone formers (103.0±12.7 mmHg), p=0.012. Diastolic BP was also significantly different between groups (65.0±8.3 vs. 61.4 ± 8.6 mmHg, p=0.019). Systolic BPi was significantly higher in the urolithiasis group (p=0.03) while there was no significant difference in diastolic BPi (p=0.45). Urolithiasis was a significant predictor of systolic Bpi in the adjusted model (β=0.04, 95%CI 0.001,0.07). The association between urolithiasis and absolute systolic BP trended toward significance (β=4.4, 95%CI -0.14,9). In stone formers, systolic BP and systolic BPi were directly associated with 24-hr urine sodium, oxalate/1.73m2 and uric acid in multiple regression analysis (all p 0.05).
We found that BP was positively associated with urolithiasis in chidren. In addition, BP was directly associated with 24-hr urine oxalate, uric acid, and sodium values. Interestingly, BP was not associated with urine calcium in this population. Further studies are needed to investigate the mechanisms behind these associations.
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