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Urinary metabolic evaluations in solitary and recurrent stone forming children
William DeFoor1, Eugene Minevich, Elizabeth Jackson
1Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. bob.defoor@cchmc.org
Insights
Children with recurrent kidney stones show higher urinary calcium levels. Early, aggressive treatment based on 24-hour urine tests can help prevent future stone formation in at-risk pediatric patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Urinary metabolic abnormalities are common in children who form kidney stones.
- A 24-hour urine evaluation is standard for assessing stone risk in pediatric patients after their first stone episode.
Purpose of the Study:
- To identify children at the highest risk for recurrent kidney stone formation.
- To analyze urinary metabolic profiles in pediatric stone formers.
Main Methods:
- Retrospective cohort study of pediatric urolithiasis patients.
- Evaluation of 24-hour urine collections for metabolic profiles, including calcium, citrate, and calcium oxalate supersaturation.
- Stratification of patients into solitary and recurrent stone formers.
Main Results:
- Recurrent stone formers exhibited significantly higher timed urinary calcium levels, adjusted for creatinine and weight.
- While calcium oxalate supersaturation was higher in recurrent stone formers, it did not reach statistical significance.
- Age and gender were comparable between solitary and recurrent stone-forming groups.
Conclusions:
- Significant differences in 24-hour urinary calcium levels distinguish solitary from recurrent calcium stone-forming children.
- Elevated urinary calcium indices in pediatric patients may warrant more aggressive initial management strategies.
- Targeted dietary and pharmacological interventions can be beneficial for preventing stone recurrence.
Purpose:
We have previously reported a high rate of urinary metabolic abnormalities in stone forming children compared to normal controls. At our institution a 24-hour urine evaluation is initiated after the first stone episode in children, to measure stone risk indices. The purpose of this study was to determine which children are at the greatest risk for recurrent stone formation.
Materials And Methods:
A retrospective cohort study was performed to assess urinary metabolic profiles in children with urolithiasis. In all patients 24-hour urine collections were performed and evaluated elsewhere. Urine chemistry assessments such as calcium and citrate were adjusted for creatinine and weight. Calcium oxalate supersaturation was measured. Patients were stratified as solitary or recurrent stone formers based on review of the medical record. Univariate analysis between means was performed with a 2-tailed t test.
Results:
A total of 148 samples from 88 solitary stone formers and 84 samples from 51 recurrent stone formers were evaluated. Age and gender were well matched between the 2 groups. Timed urinary calcium levels referenced to creatinine and citrate were significantly higher in patients with recurrent stones. Supersaturation levels of calcium oxalate were higher in recurrent stone formers but did not reach statistical significance.
Conclusions:
There are significant differences in 24-hour urinary calcium levels between solitary and recurrent calcium stone forming children. A patient with increased urinary calcium indices on a 24-hour specimen may benefit from more aggressive initial dietary and pharmacological treatment to prevent stone recurrence.
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