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Metabolic stone composition in Egyptian children
Ashraf Aggour1, Ali M Ziada, Ahmad Z AbdelHamid
1Department of Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
Insights
Pediatric urolithiasis in Egypt shows a mix of stone types, including calcium oxalate, ammonium acid urate, and calcium carbonate. This profile is intermediate, reflecting factors seen in both developing and developed nations.
Area of Science:
- Pediatric Nephrology
- Urology
- Mineralogy
Background:
- Pediatric urolithiasis (urinary stones in children) is a significant health issue, particularly in developing countries.
- Stone composition is influenced by diet, geography, and socioeconomic factors.
- Understanding local stone composition is crucial for effective treatment and prevention strategies.
Purpose of the Study:
- To analyze the chemical composition of urinary stones in a cohort of Egyptian children.
- To identify the prevalence of different stone types and their locations within the urinary tract.
- To correlate stone composition with potential etiological factors.
Main Methods:
- Prospective analysis of urinary stones from 100 pediatric patients (aged 14 months to 12 years).
- Categorization of stones based on location (upper vs. lower urinary tract).
- Chemical analysis to determine stone components.
Main Results:
- Upper urinary tract stones were predominantly calcium oxalate (47%), followed by ammonium acid urate (26%) and calcium carbonate (21%).
- Lower urinary tract stones showed a higher prevalence of ammonium acid urate (27.2%), struvite (27.2%), and calcium carbonate (22.7%).
- Urinary tract infection contributed to one-third of cases; metabolic and endemic stones were noted in 15% and 17%, respectively.
Conclusions:
- The stone composition in Egyptian children presents an intermediate profile, distinct from purely deficiency-driven stones common in some developing nations.
- This profile suggests a complex interplay of dietary, infectious, and potentially metabolic factors in pediatric stone formation in this region.
- Further research into metabolic and infectious etiologies is warranted to refine prevention and treatment approaches.
Objective:
The composition of urinary stones in children depends on socioeconomic conditions, geography and dietary habits. Pediatric urolithiasis remains endemic in developing countries. The aim of this study was to analyze stone composition in an Egyptian patient population.
Patients And Methods:
We analyzed prospectively urinary stones from 100 consecutive children (73 males, 27 females), aged 14 months to 12 years. The stones were located in the upper urinary tract in 78%, lower urinary tract in 19% and both in 3%. Male patients had more lower urinary tract stones. On presentation 67% had flank pain and 37% had hematuria. Stones were treated by open surgery in 69% of patients, shockwave lithotripsy in 20% and endoscopic extraction in 13%.
Results:
The components of the upper urinary tract calculi were calcium oxalate (47%), ammonium acid urate (26%) and calcium carbonate (21%), whereas the main components of the lower urinary tract calculi were ammonium acid urate (27.2%), struvite (27.2%) and calcium carbonate (22.7%). Urinary tract infection was involved in the development of one third of the stones. Endemic stones were present in 17% of patients, and stones of metabolic origin in 15%. The etiology of stone formation remained unknown in one third of patients.
Conclusion:
The epidemiological profile of urinary stones in Egyptian children can now be considered intermediate between developing countries where dietary deficiencies are the main causes and developed countries where infectious and metabolic calculi are observed.
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