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Spectrum of pediatric urolithiasis in western India
A M Shah1, S Kalmunkar, S V Punekar
1Department of Urology and Biochemistry, L.T.M.G. Hospital, Sion, Bombay.
Insights
Pediatric urolithiasis is uncommon but significant, with bladder stones being most frequent. Uric acid is a dominant component in most pediatric urinary tract stones, often found in mixed formations.
Area of Science:
- Urology
- Pediatric Nephrology
- Stone Disease
Background:
- Urolithiasis affects a significant number of patients, with pediatric cases representing a notable subset.
- Understanding the characteristics of pediatric urolithiasis is crucial for effective management and prevention.
Purpose of the Study:
- To analyze the epidemiological and etiological features of pediatric urolithiasis.
- To identify common stone compositions and contributing factors in children.
Main Methods:
- Retrospective analysis of 1,211 urolithiasis patients over nine years.
- Detailed examination of 77 pediatric cases, including demographics, stone site, and composition.
Main Results:
- Pediatric urolithiasis accounted for 6.4% of cases, predominantly in males aged 6-10 years.
- Urinary bladder stones were most common (67.5%), with a lower urinary tract to upper urinary tract ratio of 1:2.85.
- Stones were predominantly mixed, with high concentrations of calcium, oxalate, phosphate, and notably, uric acid (93.2% rich concentration).
Conclusions:
- Pediatric urolithiasis presents unique characteristics, with a high prevalence of mixed stones rich in uric acid.
- Dietary factors, particularly low protein intake in lower socioeconomic groups, may contribute to stone formation.
- Further research into the specific etiology and prevention strategies for pediatric uric acid stones is warranted.
Abstract:
Of 1,211 patients with urolithiasis treated at this institution over a nine years period, there were 77 (6.4%) pediatric cases. The commonest age group was 6-10 years (55.8%). Male:female ratio was 7.6:1. Hindus constituted 72.7% of the patients. There was no significant seasonal variation. The commonest site was urinary bladder (67.5%). The upper: lower urinary tract stone ratio was 1:2.85. Majority belonged to the lower-middle or poor income groups having a cereal based diet with minimal or poor protein intake. The common constituents of stones were calcium (98.7%), oxalate (87%), phosphate (84.4%) and uric acid (76.6%). Of all these, uric acid had the richest concentration (grade of ++ or more) in 93.2%. Only 4 stones (5.2%) were "pure": calcium oxalate--3 and calcium phosphate--1; whereas 73 (94.8%) were mixed stones. Of these, 9 (11.7%) were "predominant" mixed stones, with only one constituent having rich concentration (grade of ++ or more) and all others being either trace or +. The rest 64 (83.1%) were "heterogenous" mixed stones having rich concentration of more than one constituent.