Urolithiasis in childhood: Metabolic evaluation (original) (raw)
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Metabolic risk factors in children with urolithiasis: Single centre experience in southwest Turkey
Pamukkale Medical Journal, 2015
Purpose:To investigate the demographic characteristics, clinical features, and metabolic risk factors of children with urolithiasis. Materials and methods:This retrospective study included 98 patients (48 boys, 50 girls) with urolithiasis diagnosed by ultrasonography. The mean age at presentation was 59.8 (1-192) months, and the mean followup period was 5.5 (1-27) months. Clinical and laboratory data including gender, age at diagnosis, presence of family history of renal stone, follow-up duration, presenting symptoms, the history of urinary tract infection (UTI), stone localization, presence of anatomical abnormalities of the urinary tract, presence of microscopic or macroscopic hematuria, pyuria, urinary metabolic examinations, blood tests, analysis of stone composition, treatment modality, and prognosis were assessed. Results: The most common symptom was restlessness in infants (<1year) and abdominal or flank pain in older children. Microcalculi (stone diameter <3mm) and calculi (>3mm) were found in 29.6% and in 70.4% of the patients, respectively. Hypercalciuria was the most common abnormality, followed by hypomagnesiuria. Nearly half of the hypercalciuria cases were <1 year old. Recurrent urinary tract infection was detected in half of the patients. Four patients underwent extracorporeal shock-wave lithotripsy, four underwent open surgery, and the other 90 were treated with conservative treatment. Spontaneous passage occurred in 17 patients. Stone analysis revealed calcium-oxalate in 82.4% of the 17patients. At the time of their last visit, 70% of the patients that were treated with conservative treatment, either had stones that disappeared or diminished in size with appropriate therapy. Conclusion: In terms of stones disappearance or decrease in the size of the stones, it seems that children younger than 1 year have more disadvantages than older children. Microcalculi in children should be taken into consideration because we found that 3/5 of these cases had urinary metabolic abnormalities.
Metabolic factors associated with urinary calculi in children
Iranian journal of kidney diseases, 2010
We aimed to identify metabolic and anatomical abnormalities present in children with urinary calculi. Metabolic evaluation was done in 142 pediatric calculus formers. Evaluation included serum biochemistry; measurement of daily excretion of urinary calcium, uric acid, oxalate, citrate, and magnesium (in older children); and measurement of calcium, uric acid, oxalate, and creatinine in random urine samples in nontoilet-trained patients. Urinary tests for cystinuria were also performed. All of the patients underwent renal ultrasonography. Sixty-one patients (42.7%) had metabolic abnormalities. Anatomical abnormalities were found in 12 patients (8.4%). Three children (2.1%) had infectious calculi, and 3(2.1%) had a combination of metabolic and anatomic abnormalities. In 66 children (46.2 %) we did not find any reasons for calculus formation (idiopathic). Urinalysis revealed hypercalciuria in 25 (17.6%), hyperuricosuria in 23 (16.1%), hyperoxaluria in 17 (11.9%), cystinuria in 9 (6.3%),...
The Journal of Urology, 2007
The incidence of kidney stones in adults has increased in the last 30 years. This retrospective, single site review was done to test the hypotheses that the incidence of urolithiasis in pediatric patients increased from 1994 to 2005, and that metabolic abnormalities were more common in patients with renal stones in the final 3 years of the study period. Materials and Methods: Charts from 2 time periods were reviewed, 1994 to 1996 (period 1) and 2003 to 2005 (period 2). Clinical and laboratory data, including demographics, presenting complaints, laboratory assessment, treatment and outcome, were tabulated in patients with confirmed urolithiasis. Results: The number of patients with urolithiasis increased from 7 in period 1 to 61 in period 2. When expressed as cases per 100 new patients the incidence increased 4.6 times (p ϭ 0.014). Focusing on period 2, 28% of patients were younger than 10 years. While blood tests were generally normal, 76% of patients had at least 1 abnormality in the 24-hour urine collection. Hypocitraturia, which was the most common metabolic abnormality, was noted in 52% of patients. The small number of patients in period 1 precluded determination as to whether metabolic abnormalities were more common in period 2. Surgery and/or lithotripsy was required in 12 children. Stone disease recurred in 39% of the patients. Conclusions: The incidence of urolithiasis in the pediatric population increased nearly 5-fold at our institution during the last decade. We recommend that the primary diagnostic test be a 24-hour urine collection. The most common metabolic abnormality was hypocitraturia, followed by hypercalciuria. Recurrence of stones is common (approximately 40% rate) and followup is advised.
A study of urolithiasis in children admitted to a tertiary care hospital
Sri Lanka Journal of Child Health, 2019
Background: Paediatric urolithiasis is now commoner and is associated with a high risk of recurrence and an increased morbidity. Objectives: To study the clinical profile, the metabolic and anatomical risk factors predisposing to urolithiasis in children admitted to a tertiary care hospital. Method: The study included children between 1 month and 18 years of age admitted in tertiary care with a diagnosis of urolithiasis. A detailed history, including demographic data, physical examination, laboratory parameters, imaging studies, 24 hour urine for metabolic workup were noted, Stone was sent for analysis of composition. The study period was from 2012 to 2017. Results: The study group consisted of 56 children with a median age at onset of symptoms of 8.1 years. The common presenting symptoms were abdominal pain (87.5%) and fever (30.4%). Anatomical defects were associated with urolithiasis in 9 (16.1%) children. Hypocitraturia was observed in 34 (63.1%) children followed by hyperoxaluria in 20 (37%) children. Hypercalciuria was observed in 8 (14.8%) children. Majority (71.5%) of calculi were in the kidney and were constituted by calcium oxalate (75%). At follow up, 10 (22.2%) children had persisting calculi, 7 (15.5%) had a recurrence and in the remaining 28 (62.2%) children no recurrence was observed. Conclusions: Abdominal pain was the presenting symptom in 87.5% cases. Hypocitraturia was observed in 63.1% cases. Majority (71.5%) of calculi were in the kidney. There were recurrent calculi in 15.5%.
Metabolic and demographic characteristics of children with urolithiasis in Western Turkey
Urological Research, 2011
Pediatric urolithiasis is an endemic disease in Turkey. We evaluated the clinical, radiological and metabolic features of children with urolithiasis in Western Turkey. We retrospectively reviewed the records of 85 children with urolithiasis who were followed-up between 2004 and 2010 in Pediatric Nephrology Department of Celal Bayar University, Manisa. The male/female ratio was 1.23/1. The mean age at diagnosis was 66.1 months (range 3-210 months). Family history of urolithiasis was found in 58 (68.2%) patients. 23 (27%) patients were born from consanguineous marriages. Stones were located in the upper urinary tract in 79 (92.9%) patients. In 66 (77.6%) patients, stones were single-sided and 41 (48.2%) patients had multiple stones. Calcium oxalate stones were the most common one among patients in whom stone analysis was performed (78.5%). Hypocitraturia was the most commonly detected urinary metabolic risk factor. In patients who were under 12 months of age at diagnosis, hypercalciuria was the most commonly seen urinary metabolic risk factor. At the end of follow-up period, 24 patients became free of stone disease and 4 patients had recurrence. In conclusion, metabolic abnormalities are common in pediatric stone patients and are strongly associated with recurrence. Considering that urolithiasis in children is an important risk factor for renal failure, early diagnosis, detailed metabolic evaluation and implementing appropriate treatment and follow-up protocols may prevent recurrence and renal damage.
Urolithiasis in children: Current medical management
Pediatric Nephrology, 1989
The mechanism of stone formation in the urinary tract is reviewed. Diet, urinary tract infection and metabolic disorders account for the different epidemiological patterns of stone formation. The diagnosis and management of renal tract calculi are discussed. Calcium stones are associated with hypercalciuria, urine acidification defects, the use of furosemide in premature babies, hypercalcaemia, hyperoxaluria, hyperuricosuria, an alkaline urine and hypocitraturia. Uric acid stones occur in acid urine, from increased purine synthesis with lympho-or myeloproliferative disorders or from several inborn errors of purine metabolism which can also cause xanthine or dihydroxyadenine stones. Cystinuria, inherited as an autosomal recessive disorder is best treated with a low sodium diet, a fluid intake exceeding 40 ml/kg per day maintaining urine pH between 7.5 and 8 and, if necessary, with oral penicillamine. Oxalate stones occur in relation to diet, bowel disease and primary inherited defects in oxalate metabolism. Urinary tract infection causing struvite and carbonate apatite formation is the commonest cause of stones in Europe.
Pediatric Primary Urolithiasis: 12-Year Experience at a Midwestern Children's Hospital
The Journal of Urology, 2013
Purpose: Due to environmental and social changes (and possibly obesity) as new risk factors for stone formation in adults and changes in imaging techniques, we assessed whether etiologies of primary pediatric urolithiasis have changed, and if relationships exist between the condition and obesity or imaging technique. Materials and Methods: All pediatric patients with documented primary urolithiasis who underwent serum and 24-hour urine analyses between 1999 and 2010 were evaluated. Age at diagnosis, gender, body mass index and imaging technique were recorded. Results: Of the 222 patients (48% male) all had normal serum creatinine, electrolytes and minerals. Primary pediatric urolithiasis was diagnosed by ultrasound in 73% of cases and computerized tomography in 27%. Mean Ϯ SD annual incidence of urolithiasis per 1,000 clinic visits increased from 2.4 Ϯ 1.5 in the first half of the study period to 6.2 Ϯ 2.1 in the second half (p Ͻ0.005). Mean Ϯ SD age at diagnosis was 11.8 Ϯ 3.8 years and body mass index was 21.7 Ϯ 5.7 (rate of overweight 15%). A total of 140 patients had urine output less than 1.0 ml/kg per hour, with this being the only abnormality in 54. Hypercalciuria was observed in 46% of patients, hypocitraturia in 10% and high calcium-to-citrate ratio in 51%. Mild absorptive hyperoxaluria was noted in 3 patients and hyperuricosuria in 11, with all 14 exhibiting at least 1 additional abnormality. Cystinuria was present in 1 patient. No etiology was identified in 20 patients (9.0%). Conclusions: Oliguria and hypercalciuria continue to be the most common etiologies of pediatric primary urolithiasis, followed by hypocitraturia. The recent increase in stone incidence is unlikely due to increased use of computerized tomography. Incidence of obesity was not higher than in the general population. Hyperoxaluria and cystinuria are rare, and thus might not be indicated in the initial analysis.
Clinical course of pediatric urolithiasis: follow-up data in a long-term basis
International Urology and Nephrology, 2011
Objective To evaluate the natural course of the stone disease in pediatric patients from different perspectives among which the spontaneous passage and stone recurrence rates evaluated during the follow-up. Materials and methods A total of 142 children referring with primary urinary stone disease were evaluated and followed. All children in the study were divided into two groups with respect to the age (Group 1: 0-5 years and Group 2: 6-15 years). Children were followed with respect to spontaneous passage rates, recurrence-regrowth rates, physical as well as the renal growth rates. Results Stone recurrence has been noted in 44% of patients in group 1, this value was 31% in group 2. Children with at least one identifiable metabolic abnormality tended to have higher recurrence rates than the others despite conservative measures. The average stone recurrence rate in children without any metabolic abnormality was 14% and nearly 50% in children with an identifiable metabolic abnormality. Conclusions We may emphasize that due to the high recurrence and re-growth rates, all children with urinary stone disease should be followed closely with regular visits. The evaluation of metabolic risk factors in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of pre-existing calculi.
Evaluation of children with urolithiasis
Indian Journal of Urology, 2007
To describe an evaluation protocol for pediatric stone formers for risk assessment and management strategies. Between 2002-2006, 2618 children of age three months to 15 years were evaluated for stone disease. Evaluation included demographics, history, anthropometry, diet, ultrasound, X-ray KUB, IVU, blood and 24h urine chemistry and cultures. Stones were analyzed by IR spectroscopy. The median age was seven years with a M:F ratio of 2.2:1. Of the 2618 patients, 2216 presented with normal renal function and 402 with renal failure. Main symptoms were abdominal pain (33%), flank pain (38%) and fever (38%). Renal failure patients also had shortness of breath (38%) and oligo-anuria (26%). Children were malnourished with height and weight deficits in 65% and 76% respectively. Diet was low in protein (74%), calcium (55%) and fluids in (55%), high in oxalate (55%), sodium (39%), purines (42%) and refined sugar (41%). Overall urine cultures were positive in 1208 (46%) with E. coli (38%) and ...