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[Clinical and laboratory tests characteristics in children with nephrolithiasis: case control study]
Víctor Arízaga-Ballesteros1, Carlos Alberto Cuello-García
1Departamento de Pediatría, Escuela de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey (ITESM), Campus de la Salud, Monterrey NL, México.
Insights
Pediatric urolithiasis risk is low in children with abdominal pain if they have fever, no gross hematuria, and no family history of kidney stones. These factors provide a 100% negative predictive value for identifying low-risk cases.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Diagnostics
Context:
- Urolithiasis in children presents diagnostic challenges.
- Identifying low-risk patients is crucial for efficient healthcare resource allocation.
- Abdominal pain is a common symptom in pediatric emergency care.
Purpose:
- To identify clinical and laboratory predictors of low risk for pediatric urolithiasis.
- To evaluate findings in pediatric patients with urolithiasis using a case-control study.
- To develop a predictive model for low-risk urolithiasis in children.
Summary:
- A case-control study analyzed 24 pediatric urolithiasis cases and 29 controls.
- Key differentiating factors included fever, hematuria, costovertebral angle tenderness, family history, and duration of abdominal pain.
- Fever, absence of gross hematuria, and no family history of urolithiasis demonstrated 100% negative predictive value and sensitivity.
Impact:
- Establishes a reliable, non-invasive method for ruling out pediatric urolithiasis.
- Aids clinicians in risk stratification for children presenting with abdominal pain.
- Potential to reduce unnecessary investigations and improve patient management pathways.
Objectives:
To evaluate the clinical and laboratory findings in pediatric patients with urolithiasis in a case control study and to obtain variables predicting a low risk of having urolithiasis.
Methods:
Retrospective analysis of 24 cases of children with urolithiasis (age range 3 to 17 years old) admitted to the pediatric emergency room or the hospital ward. Clinical and laboratory information was obtained from the clinical charts and compared with a control group of 29 patients with history of abdominal pain admitted to the hospital. Binary logistic regression and recursive partitioning analysis were used to obtain variables predicting a low risk of having urolithiasis.
Results:
There was no difference in age, gender, dysuria or nausea (p > 0. 2) between groups. A difference regarding the presence of fever (p = 0.007), haematuria (p = 0.001), costovertebral angle tenderness (p = 0.004), family history (p = 0.007) and abdominal pain lasting more than 48 hs (p = 0.04) was detected. After logistic regression and using recursive partitioning, the presence or history of fever, absence of gross haematuria and no family history of urolithiasis showed a 100% negative predictive value and sensitivity (95% CI 84.7 to 100 and 89.2 to 100 respectively).
Conclusions:
Children with abdominal pain present a low risk of having urolithiasis if there is a history or presence of fever, absence of gross haematuria and a negative family history of urolithiasis in a first degree relative.
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