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Urinary stone disease in the first year of life: is it dangerous?
Harika Alpay1, Ibrahim Gokce, Ahmet Özen
1Division of Pediatric Nephrology, Department of Pediatrics, Medical Faculty, Marmara University, Istanbul, Turkey. dhtalpay@superonline.com
Insights
Infantile urolithiasis (UL) in infants under one year presents unique clinical, radiological, and metabolic features. High rates of urinary tract infections and metabolic abnormalities necessitate specific screening and management strategies for this distinct pediatric condition.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Infantile urolithiasis (UL) is a rare condition in children under one year of age.
- Understanding its unique characteristics is crucial for appropriate diagnosis and management.
- Previous studies have focused on older children, leaving a gap in knowledge for the infantile population.
Purpose of the Study:
- To evaluate the clinical, radiological, and metabolic features of infantile urolithiasis (UL).
- To compare infantile UL with that in older children.
- To identify potential distinct pathogenetic mechanisms and inform follow-up screening.
Main Methods:
- Retrospective review of medical records for 93 children diagnosed with UL before one year of age.
- Data collected included demographics, age at diagnosis, symptoms, family history, stone characteristics, and urinary metabolic evaluations.
- Comparison with previously reported data on older children with UL.
Main Results:
- A family history of UL was present in 56.2% of cases.
- Urinary tract infections (UTIs) were common, affecting 65.9% of females and 46.2% of males.
- Metabolic abnormalities, primarily hypercalciuria, were found in 79.5% of children; 16.1% had accompanying systemic disorders.
Conclusions:
- Infantile UL should be considered a separate clinical entity within pediatric urolithiasis.
- High frequencies of systemic disorders, anatomic anomalies, UTIs, and metabolic abnormalities suggest distinct pathogenetic mechanisms.
- Screening for UTIs and metabolic abnormalities is recommended during the follow-up of infants with UL.
Purpose:
We have evaluated the clinical, radiological and metabolic features of infantile urolithiasis (UL).
Materials And Methods:
We have reviewed the medical records of 93 children who were diagnosed as having UL before 1 year of age. We recorded patient demographics, the age at diagnosis, presenting symptoms, family history, the localizations and dimensions of stones, urinary metabolic examinations, as well as physical, laboratory, and radiologic findings. Our secondary objective was to compare some features of this group with those of older children with UL followed-up in the same clinic which were previously reported.
Results:
We evaluated 93 children referred to our pediatric nephrology clinics. A family history of UL was 56.2 % in the study group. Resolution of stones was observed in 30.1 % of the cases. Urinary tract infections (UTIs) were detected in 65.9 % of females and 46.2 % of males. At least one urinary metabolic abnormality was found in 79.5 % of all the children. Most commonly seen metabolic abnormality was hypercalciuria. In all patients stones were located in kidneys except one infant who had an ureteral stone together with a kidney stone. Fifteen (16.1 %) children had an accompanying systemic disorder.
Conclusions:
Among pediatric urinary stone diseases infantile UL can be regarded as a separate clinical entity. Coexistence of systemic disorders and anatomic anomalies at high frequencies may indicate a role of distinct pathogenetic mechanisms. In addition, high rates of UTIs and metabolic abnormalities in this age group justify screening for these parameters during follow-up of these children.
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