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Pediatric urolithiasis in Armenia: a study of 198 patients observed from 1991 to 1999
A Sarkissian1, A Babloyan, N Arikyants
1Arabkir Medical Center, Yerevan, Armenia.
Insights
Pediatric urolithiasis in Armenia shows a shift towards urban patterns, with calcium oxalate stones being most common. Infectious and endemic stones remain prevalent, though declining.
Area of Science:
- Urology
- Pediatric Nephrology
- Mineral Metabolism
Background:
- Urolithiasis in children presents unique etiological challenges.
- Understanding regional variations in stone composition and causes is crucial for effective management.
- Armenia's healthcare system has undergone significant changes, potentially impacting disease patterns.
Purpose of the Study:
- To prospectively investigate the risk factors and etiology of urolithiasis in pediatric patients.
- To analyze the stone composition and identify etiological factors in children under 15 years old.
- To compare findings with international data and assess the impact of societal changes.
Main Methods:
- Prospective study of pediatric urolithiasis patients admitted between 1991-1999.
- Stone analysis using infrared spectroscopy and urine chemical analysis.
- Data collection on patient demographics, stone location, and treatment methods.
Main Results:
- Calcium oxalate was the predominant stone constituent (62% renal, 72% bladder).
- Metabolic etiology was identified in 31% of cases, infectious in 20%, and endemic in 19%.
- Stone composition and metabolic etiology resemble Western data, but infectious and endemic stones are still significant.
Conclusions:
- Pediatric urolithiasis in Armenia exhibits a mixed etiology, reflecting a transition from rural to urban societal influences.
- While metabolic and compositional profiles align with global trends, infectious and endemic factors persist.
- Continued monitoring is essential to track evolving patterns of pediatric urolithiasis.
Abstract:
To study prospectively the risk factors and etiology of urolithiasis in all stone patients aged <15 years admitted from 1991 to 1999 to the Arabkir hospital in Yerevan. Stones were obtained by surgery (64%), extracorporeal shockwave lithotripsy (ESWL) (7%) or cystoscopic extraction (4%); 25% passed spontaneously. All were examined by infrared spectroscopy, and spot urines were analyzed chemically. 198 patients, 180 (68% males) with renal stones and 18 (83% males) with primary bladder stones, were studied. Calcium oxalate (CaOx) was the predominant constituent in 62% of the kidney stones, followed by struvite (17%), calcium phosphate (7%), uric acid (7%), ammonium acid urate (5%), and cystine (2%). Bladder stones contained CaOx in 72%, uric acid in 22% and ammonium acid urate in 6% of patients. Etiology was obviously metabolic in 5% and possibly metabolic in 26%. Twenty percent of stones were infectious, and 19% were endemic (9% bladder and 10% kidney stones); 4% were secondary to urinary stasis with malformation but no infection. Etiology in 26% remained unknown. Stone composition and metabolic etiology are similar to that in central Europe and North America. In contrast, infectious calculi and particularly endemic stones are still common, although becoming less so now. Urolithiasis in Armenia thus reflects the transition from a rural to an urban society.
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