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Epidemiology of paediatric renal stone disease in the UK
R J M Coward1, C J Peters, P G Duffy
1Nephro-Urology Unit, Institute of Child Health, London, UK. Richard.Coward@bristol.ac.uk
Insights
Metabolic abnormalities are now the leading cause of paediatric kidney stones in Britain, often masked by infections. Advanced minimally invasive surgeries are now standard treatment for pediatric urolithiasis.
Area of Science:
- Pediatric Nephrology
- Urology
- Epidemiology
Background:
- The last comprehensive epidemiological study on pediatric nephrolithiasis in Britain was over 30 years ago.
- Recent data is needed to understand current trends in pediatric kidney stones.
Purpose of the Study:
- To investigate the current presenting features of pediatric renal stones.
- To identify predisposing factors and analyze treatment strategies for pediatric urolithiasis.
- To update the understanding of pediatric nephrolithiasis epidemiology in the UK.
Main Methods:
- Retrospective review of 121 children with urinary tract renal stones treated between 1997-2001.
- Inclusion of data from one adult and one pediatric center.
- Comprehensive infective and metabolic work-up for all pediatric patients.
Main Results:
- Metabolic abnormalities were identified in 44% of pediatric patients, compared to 30% infective and 26% idiopathic causes.
- Bilateral stones were more frequent in the metabolic group (26%) versus infective/idiopathic (12%).
- Minimally invasive surgical techniques were utilized in 68% of pediatric cases.
Conclusions:
- A significant shift in pediatric renal stone disease epidemiology in the UK has occurred over 30 years.
- Metabolic causes are now predominant, though potentially obscured by concurrent urinary tract infections.
- Modern treatment emphasizes minimally invasive surgical approaches, and metabolic screening is recommended for all pediatric stone patients.
Background:
The previous epidemiological study of paediatric nephrolithiasis in Britain was conducted more than 30 years ago.
Aims:
To examine the presenting features, predisposing factors, and treatment strategies used in paediatric stones presenting to a British centre over the past five years.
Methods:
A total of 121 children presented with a urinary tract renal stone, to one adult and one paediatric centre, over a five year period (1997-2001). All children were reviewed in a dedicated stone clinic and had a full infective and metabolic stone investigative work up. Treatment was assessed by retrospective hospital note review.
Results:
A metabolic abnormality was found in 44% of children, 30% were classified as infective, and 26% idiopathic. Bilateral stones on presentation occurred in 26% of the metabolic group compared to 12% in the infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting urinary tract infection was common (49%) in the metabolic group. Surgically, minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and endoscopy) were used in 68% of patients.
Conclusions:
There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years. Underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection. Treatment has progressed, especially surgically, with sophisticated minimally invasive techniques now employed. All children with renal stones should have a metabolic screen.
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