The prevalence of celiac disease in children with urolithiasis

Introduction and Aim: Celiac disease is a chronic inflammatory malabsorption disease of the small intestine mediated by antibodies produced against dietary gliadine which is found in wheat, barley and rye. The prevalence of the disease ranges between 1/100 to 1/300 and accounts for the most prevalent malabsorption disorder of the childhood. Classical manifestations of the disease includes malabsorption, failure to thrive, diarrhea, abdominal distantion and steatorrhea but recently it is widely accepted that the disease may present with several atypical clinical findings. Recently, studies investigating the association between celiac disease and urinary pathologies have been accelerated, but the studies concerning the association of celiac disease and urolithiasis are insufficient. We aimed to investigate the possible association between celiac disease and urolithiasis which may contribute to the understanding of the atypical aspects of the celiac disease.Material and Methods: The risk group consisted 187 children ranging from 4 months ? 17 years of age, having diagnosed as urolithiasis, being followed by the Pediatric Nephrology department of the İnönü University Medical Faculty (Malatya, Turkey) between June 2008 and August 2010. The control group consisted 278 children who applied to the General Pediatric Policlinic due to acute illnesses, having similar age ranges and sex distribution with the risk group. Both groups were analyzed with serum tTG, IgA, AST, ALT, CK levels and complete blood count. Seropositive cases were re-evaluated, endoscopic biopsies were performed and analysed.Results: Seven children from the risk group 1/27 (%3,7) and one child from the control group 1/278 (0,3) were found seropositive. The risk group showed significantly higher seropositive results compared to the control group (p=0,008). Six children of seven children who were found seropositive from the risk group were undergone endoscopy and duodenal biopsies were performed, and two of this six children?s biopsies revealed positive pathology for celiac disease according to Marsh-Oberhuber pathologic criterion. One child who was found seropositive for celiac disease from the control group did not accept to undergo endoscopy. All participants serum IgA levels were performed. Serum IgA levels of the control group were found normal according to age and one case from the study group (1/187-%0,3) had low serum IgA levels according to age. This only case was studied with TTG IgG and AGA IgG and normal results were obtained. The mineral analysis of the four of the seven seropositive cases from the risk group were performed; three patients had calcium oxalate, one had uric acid stones. Mineral analysis of one of the two biopsy confirmed celiac patients revealed calcium oxalate stone. The antropometric values of the risk group were found lower than the control group. Urinary symptomatology were found to be more prevalent among the tTG positive and biopsy positive cases compared to the negative cases but this feature is not statistically significant. Recurrent abdominal pain and dental caries were positive findings for both biopsy positive two cases and found to be statistically significant (respectively p=0,02 and p=0,012).Conclusion: Celiac disease was found statistically higher among children with urolithiasis compared to the control group (1/27-1/278). ?Biopsy proven? celiac disease prevalence of the risk group was similar with the normal population prevalence values of the celiac disease. The sufficient data for the recommendation of celiac disease screening among the urolithiasis patients was not obtained but more healthy results may be obtained with the follow up of the seropositive cases and future studies with larger series.Key words: celiac disease, urolithiasis, prevalence