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Pediatric urolithiasis--evaluation of risk factors in 95 children
Ahmet Erbagci1, Ayse Binnur Erbagci, Meryem Yilmaz
1Department of Biochemistry, Medical School, University of Gaziantep, TR-27070 Kolejtepe, Gaziantep, Turkey. gantepuro@hotmail.com
Insights
Pediatric urolithiasis requires thorough metabolic and environmental evaluation for recurrent stone disease. Addressing urinary tract infections and promoting increased urine volume with citrate therapy are key for managing pediatric kidney stones.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Pediatric urolithiasis is uncommon globally but endemic in regions like Turkey.
- It's a recurrent condition that can lead to urinary tract changes.
- Evaluation must include metabolic, environmental, and urogenital factors.
Purpose of the Study:
- To prospectively evaluate patient/family history, serum, and urine risk factors in children with urolithiasis.
- To identify common risk factors and correlations in pediatric stone disease.
- To assess treatment outcomes and recurrence in pediatric patients.
Main Methods:
- Studied 95 children (1996-2001) with urolithiasis.
- Assessed stone localization, UTI, family history, serum/urine risk factors (hypocitraturia, hypercalciuria, etc.), diet, and 24-h urine volume.
- Excluded children with cystinuria.
Main Results:
- Hypocitraturia was the most common risk factor.
- Positive family history (54%) and UTI (62%) were frequent.
- Significant correlations found between stone size and urinary citrate, and UTI and urinary phosphate.
Conclusions:
- Pediatric urolithiasis necessitates individualized metabolic and environmental assessment.
- Immediate correction of obstructive pathologies and treatment of metabolic abnormalities are crucial.
- Encourage increased urine volume and citrate-boosting therapies, especially for those with a family history.
Objective:
Pediatric urolithiasis is a rarely encountered pathology, except in endemic areas such as Turkey. As a recurrent pathology which may reveal functional as well and morphologic changes in the urinary tract, metabolic and environmental factors, in addition to urogenital abnormalities, should be evaluated thoroughly in each patient. In this prospective study, the patient and family histories of 95 children with stone disease were evaluated, together with serum and urine risk factors.
Material And Methods:
Between 1996 and 2001, 95 children (25 females, 70 males; mean age 7.3 years; age range 0.6-15 years) referred to our department with urolithiasis were evaluated. All patients were investigated with respect to stone localization, associated abnormalities, urinary tract infection (UTI), positive family history and serum and urine risk factors. In addition to standard risk factors (hypocitraturia, hypercalciuria, hyperoxaluria, hyperuricosuria, hypomagnesuria), diet and 24-h urine volume were also assessed in all children. Children with cystinuria were excluded from the study.
Results:
Stone size ranged from 0.3 to 3.3 cm, with an average value of 2.0 cm. The localization of the stones was classified as unilateral single stone in 37 patients, multiple unilateral stones in six and bilateral multiple stones in 27. Hypocitraturia was the commonest risk factor detected in our patients. A positive family history was present in 51 cases (54%). In addition, UTI was present in 59 cases (62%) and 67 cases had a previous history of recurrent UTI. Associated urogenital abnormality was detected in nine cases (9.4%). There were significant correlations between stone size and urinary citrate excretion (p < 0.05) and between the presence of UTI and urinary phosphate excretion (r = 0.59, p = 0.047). Treatments used were open surgery in seven (7.3%) cases, extracorporeal shock-wave lithotripsy in 39 (41%) and endoscopic surgery in 20 (21%). Following these procedures, 39 (41%) patients were completely stone-free, 11 (11%) had residual stones (<5 mm in diameter) and 12 (14.8%) passed the stone(s) spontaneously. During follow-up, regrowth was seen in four (4.2%) patients and stone recurrence was noted in a further four (4.2%).
Conclusions:
In addition to stone removal, treatment of pediatric urolithiasis requires a thorough metabolic and environmental evaluation of all patients on an individual basis. Obstructive pathologies have to be corrected immediately and apparent metabolic abnormalities should also be treated. Children with a positive family history should be followed carefully with respect to stone recurrence. Urine volume increases in parallel with body mass index and medical therapeutic agents which increase urine citrate levels should be encouraged.