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Etiological and clinical patterns of childhood urolithiasis in Iraq
Shatha Huusain Ali1, Usama Nihad Rifat
1Department of Pediatrics, College of Medicine, Al-Nahrain University, P.O. Box 70074, Baghdad, Iraq. shathah666@yahoo.com
Insights
Pediatric urolithiasis in Iraq presents early, with metabolic disorders being the primary cause in over half of cases. Managing urinary tract infections is crucial, as they can mask underlying metabolic issues in young stone formers.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Urolithiasis is a significant health concern in children.
- Understanding the etiological and clinical aspects of pediatric urolithiasis is essential for effective management.
- Previous studies on pediatric urolithiasis in Iraq are limited.
Purpose of the Study:
- To investigate the etiological factors and clinical characteristics of urolithiasis in Iraqi children.
- To determine the prevalence of metabolic disorders and urinary tract infections (UTIs) in pediatric stone formers.
- To identify risk factors and patterns of urolithiasis in a pediatric population in Iraq.
Main Methods:
- A retrospective study evaluating 204 children diagnosed with renal calculi between 1999 and 2004.
- Data collected included patient demographics, age of onset, clinical presentation, family history, consanguinity, stone location, and etiological factors.
- Etiological workup included metabolic investigations and assessment for anatomical defects and recurrent UTIs.
Main Results:
- The majority of patients (61.3%) were under 5 years old, with a male to female ratio of 2.8:1.
- Hematuria (44.6%) and pain (28.4%) were the most common presentations. Metabolic disorders accounted for 52% of cases, followed by infective causes (25.5%).
- Recurrent UTIs were present in 36.8% of the metabolic group, and 14.2% had staghorn calculi, often associated with UTI.
Conclusions:
- Urolithiasis in Iraqi children has an early onset and is predominantly caused by metabolic disorders, which can be exacerbated or masked by urinary tract infections.
- Comprehensive metabolic assessment and diligent management of UTIs are critical for the effective treatment and prevention of urolithiasis in pediatric patients.
- This study highlights the importance of early diagnosis and tailored management strategies for pediatric urolithiasis in the region.
Abstract:
This study was conducted to evaluate the etiological and clinical characteristics of urolithiasis in Iraqi children. From 1999 to 2004, 204 children with renal calculi were evaluated. The age range of the patients was 4 months to 14 years, 61.3% of the patients were under 5 years. Male to female ratio was 2.8:1. The mean age at onset of symptoms was 3.2 years, and stone disease was diagnosed at a mean of 3.5 years. Hematuria (44.6%) and pain (28.4%) were the main clinical presentation. Of the 204 patients 45.1% had a family history of stones. Consanguinity was recorded in 72%; 75.5% had metabolic disorders. Stones were located at multiple sites in 80 patients, or 39.2%; 58 of these 80, or 72.5%, had metabolic disorders. Multiple stones were present in 47 (23%); 72.3% were related to metabolic disorders. In 126 patients, or 61.8%, both kidneys were involved equally. Bladder stones were found in 11.3%. Staghorn calculi occurred in 29 patients, or 14.2%; 27 of these had recurrent urinary tract infection (UTI). Nephrocalcinosis was diagnosed in 7, or 3.4%; all had metabolic disorders. Etiology of stone formation was established in 189 patients, or 92.6%, whereas 15, or 7.4%, had idiopathic stones. Metabolic disorders were the commonest cause in 106 patients (52%); 52 patients were classified as infective (25.5%). Anatomical defects were present in 25 (12.2%) and 6 children (2.9%) with primary endemic bladder calculi. Coexisting UTI was common (36.8%) in the metabolic group. We concluded that urolithiasis is a serious problem among Iraqi children, with early onset of presentation. Metabolic disorders were the major causes, but can be masked by associated UTI. Proper management of UTI with a careful metabolic assessment of young stone formers is valuable in combating urolithiasis.
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