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Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition
Published on: June 21, 2024
Diagnostic examination of the child with urolithiasis or nephrocalcinosis
1Department of Pediatrics, Division of Pediatric Nephrology, University Children's Hospital Cologne, Kerpenerstr. 62, 50924, Cologne, Germany. bernd.hoppe@uk-koeln.de
Insights
Pediatric urolithiasis and nephrocalcinosis are common and often missed. Early, thorough diagnosis in children presenting with abdominal pain or hematuria is crucial for identifying stones and underlying metabolic causes.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Diagnostics
Background:
- Urolithiasis (kidney stones) and nephrocalcinosis (kidney calcifications) are more common in children than often recognized.
- These conditions are frequently underdiagnosed due to subtle or misleading symptoms, including abdominal pain and hematuria.
Purpose of the Study:
- To emphasize the importance of thorough diagnostic evaluation for pediatric urolithiasis and nephrocalcinosis.
- To highlight the need for early detection to prevent complications like recurrent stones and renal failure.
Main Methods:
- Clinical evaluation including patient and family history, and physical examination.
- Diagnostic imaging such as ultrasound, plain abdominal films, and non-enhanced computed tomography (CT) to locate stones and identify urinary tract anomalies or obstruction.
- Metabolic evaluation to rule out underlying disorders.
Main Results:
- Colicky abdominal pain and macroscopic hematuria warrant thorough investigation for urolithiasis in children.
- Abdominal symptoms can be the primary presentation of kidney stones.
- Imaging is essential for stone localization and identifying associated urinary tract issues.
Conclusions:
- Early and comprehensive diagnostic evaluation is mandatory for all children with urolithiasis or nephrocalcinosis.
- Identifying and treating metabolic causes is critical to prevent recurrent stone formation and potential renal failure.
- Kidney stones are a sign of an underlying issue requiring prompt medical attention.
Abstract:
Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis.
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