Related Experiment Videos
Clinical outcome of pediatric stone disease
Paul K Pietrow1, John C Pope, Mark C Adams
1Divisions of Pediatric Urology and Biostatistics, Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Pediatric urinary stone disease outcomes show younger children have more renal stones and lower passage rates. Metabolic evaluation is crucial for identifying recurrence risk in children with urinary calculi.
Area of Science:
- Pediatric Urology
- Nephrology
- Metabolic Disorders
Background:
- The natural history of pediatric stone disease requires further definition.
- Understanding clinical outcomes in children with urinary calculi is essential for effective management.
Purpose of the Study:
- To evaluate the clinical outcomes of pediatric patients diagnosed with urinary calculi.
- To analyze factors influencing stone passage, recurrence, and metabolic abnormalities in children.
Main Methods:
- Retrospective review of 129 pediatric patients with primary urinary lithiasis over 8 years.
- Analysis of age, stone location (renal vs. ureteral), stone size, spontaneous passage, and recurrence.
- Patients categorized into three age groups: 0-5, 6-10, and 11-18 years.
Main Results:
- Younger children (0-5 years) predominantly had renal stones (68%), while older children (11-18 years) more frequently had ureteral stones (82%).
- Spontaneous passage rates for ureteral stones were consistent (61-64%) across age groups for stones ≤5 mm; larger stones rarely passed spontaneously.
- Metabolic abnormalities were identified in 50% of children aged 0-10 years, associated with a higher recurrence rate (50% in younger children vs. 33% overall).
Conclusions:
- Younger children with urinary calculi are more prone to renal stones and have lower spontaneous passage rates.
- Ureteral stone passage is consistent across ages for stones ≤5 mm, with larger stones rarely passing spontaneously.
- Metabolic evaluation is recommended for all children with stones due to a significantly higher risk of recurrence in those with identified metabolic disorders.
Purpose:
The natural history of stone disease in children is not well defined. We evaluated the clinical outcome in children with urinary calculi.
Materials And Methods:
An 8-year retrospective review of 129 pediatric patients with primary urinary lithiasis was performed. Age, renal versus ureteral stone location, stone size, spontaneous passage, recurrence and metabolic evaluation were considered. Patients were divided into groups 1-0 to 5, 2-6 to 10 and 3-11 to 18 years old.
Results:
Of the 25 group 1 patients 17 (68%) had renal and 8 (32%) had ureteral stones. Of the 36 group 2 patients 13 (36%) had renal and 23 (64%) had ureteral stones. Of the 68 group 3 patients 12 (18%) had renal and 56 (82%) had ureteral stones. These differences in stone location according to age were not due to chance (p <0.0001). In groups 1 to 3 renal calculi an average of 6.7, 9.2 and 6.8 mm. spontaneously passed in 24%, 8% and 50% of cases, while ureteral calculi an average of 4.5, 3.5 and 3.2 mm. passed in 63%, 61% and 64%, respectively. The spontaneous passage rate of ureteral stones was consistent in the 3 age groups and for stone size up to 5 mm. Only 1 stone greater than 5 mm. passed spontaneously at any age. The incidence of identifiable metabolic abnormalities believed responsible for stone disease was 50% in groups 1 and 2, and 38% in group 3. In all age groups there was symptomatic and/or radiographic stone recurrence in a third of the patients with an identifiable metabolic abnormality, such as hypercalciuria, hypocitruria, renal tubular acidosis and so forth. In children 10 years or younger this incidence increased to 50%. Less than 10% of those with no identifiable metabolic disorder have had recurrent stones to date.
Conclusions:
Younger patients are more likely to present with renal calculi and less likely to pass these stones, probably due to the relatively larger stone burden and location. The passage rate for ureteral calculi is surprisingly consistent in all age groups with stones greater than 5 mm. rarely passing spontaneously. Half of the children 10 years or younger who present with urinary calculi have an identifiable metabolic disorder. Thus, all children with stones should undergo metabolic evaluation. In addition, these children are nearly 5-fold more likely to have recurrent stones than those with no identifiable metabolic disorder. Thus, they should be followed aggressively.