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Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome
Kristy VanDervoort1, Jonathan Wiesen, Rachel Frank
1Department of Pediatrics, Division of Nephrology, Schneider Children's Hospital, North Shore-Long Island Jewish Medical Center, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
Insights
Pediatric kidney stone (urolithiasis) incidence rose nearly fivefold over a decade. A 24-hour urine collection is recommended, revealing hypocitraturia as the most common abnormality.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Adult kidney stone incidence has risen significantly over the past 30 years.
- This trend prompted an investigation into pediatric urolithiasis rates and associated metabolic factors.
Purpose of the Study:
- To determine if pediatric urolithiasis incidence increased between 1994 and 2005.
- To assess if metabolic abnormalities were more prevalent in pediatric renal stone patients in the later study years.
Main Methods:
- Retrospective chart review of pediatric patients with confirmed urolithiasis.
- Data collected from two periods: 1994-1996 and 2003-2005.
- Analysis of clinical and laboratory data, including demographics and 24-hour urine collections.
Main Results:
- Pediatric urolithiasis incidence increased 4.6-fold (p=0.014) from period 1 to period 2.
- In the later period, 28% of patients were under 10 years old.
- 52% of patients exhibited hypocitraturia, the most common metabolic abnormality found in 24-hour urine collections.
Conclusions:
- Pediatric urolithiasis incidence significantly increased at the institution.
- A 24-hour urine collection is recommended as a primary diagnostic tool.
- Hypocitraturia and hypercalciuria are common metabolic abnormalities; stone recurrence is frequent, necessitating follow-up.
Purpose:
The incidence of kidney stones in adults has increased in the last 30 years. This retrospective, single site review was done to test the hypotheses that the incidence of urolithiasis in pediatric patients increased from 1994 to 2005, and that metabolic abnormalities were more common in patients with renal stones in the final 3 years of the study period.
Materials And Methods:
Charts from 2 time periods were reviewed, 1994 to 1996 (period 1) and 2003 to 2005 (period 2). Clinical and laboratory data, including demographics, presenting complaints, laboratory assessment, treatment and outcome, were tabulated in patients with confirmed urolithiasis.
Results:
The number of patients with urolithiasis increased from 7 in period 1 to 61 in period 2. When expressed as cases per 100 new patients the incidence increased 4.6 times (p = 0.014). Focusing on period 2, 28% of patients were younger than 10 years. While blood tests were generally normal, 76% of patients had at least 1 abnormality in the 24-hour urine collection. Hypocitraturia, which was the most common metabolic abnormality, was noted in 52% of patients. The small number of patients in period 1 precluded determination as to whether metabolic abnormalities were more common in period 2. Surgery and/or lithotripsy was required in 12 children. Stone disease recurred in 39% of the patients.
Conclusions:
The incidence of urolithiasis in the pediatric population increased nearly 5-fold at our institution during the last decade. We recommend that the primary diagnostic test be a 24-hour urine collection. The most common metabolic abnormality was hypocitraturia, followed by hypercalciuria. Recurrence of stones is common (approximately 40% rate) and followup is advised.
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