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Demographic characteristics and metabolic risk factors in Croatian children with urolithiasis
Danko Milošević1, Danica Batinić, Daniel Turudić
1University Children's Hospital, University of Zagreb School of Medicine and Clinical Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia, danko.milosevic@zg.t-com.hr.
Insights
Pediatric urolithiasis incidence is rising, with calcium oxalate stones being most common. Conservative therapy effectively prevents recurrence in most children with urinary stones.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Gastroenterology
Background:
- Urolithiasis (urinary stone disease) affects children, with incidence rates varying globally.
- Understanding the epidemiology and metabolic profiles of pediatric urolithiasis is crucial for effective management and prevention.
Purpose of the Study:
- To assess the demographic characteristics, clinical presentation, metabolic features, and treatment outcomes of pediatric urolithiasis in a Croatian cohort.
- To analyze trends in incidence and identify common stone compositions and associated risk factors.
Main Methods:
- Retrospective analysis of 76 children diagnosed with urolithiasis between 2002 and 2011.
- Data collection included patient demographics, clinical symptoms, stone location and analysis, metabolic workup (including urine saturation), and treatment modalities.
- Incidence rates were calculated and compared to national data.
Main Results:
- A two-fold increase in incidence rate was observed during the study period, with an estimated overall rate of 6.5/100,000 children in Croatia.
- The most common symptoms were renal colic (75.0%) and hematuria (57.89%). Calcium oxalate stones accounted for 75.0% of analyzed stones.
- Hypercalciuria (47.37%) and hyperoxaluria (18.42%) were the most frequent metabolic disturbances. Elevated urine saturation was found in 61.84% of cases.
- Conservative therapy, including fluid/diet recommendations and medication, was successful in preventing recurrence in 92.1% of children.
Conclusions:
- Pediatric urolithiasis is an increasing health concern in Croatia, characterized by a predominance of calcium oxalate stones and significant metabolic abnormalities.
- Conservative management strategies are highly effective in preventing stone recurrence in pediatric patients.
- Further research into the specific causes and long-term outcomes of pediatric urolithiasis in the region is warranted.
Abstract:
The aim of this study was to assess demographic data, clinical presentation, metabolic features, and treatment in 76 children with urolithiasis presented from 2002 to 2011. Urolithiasis is responsible for 2.5/1,000 pediatric hospitalizations, with new cases diagnosed in 1.1/1,000 admissions. From the observed period, two-fold rise of incidence rate was observed. Compiling the data from other pediatric institutions in our country, we estimated present overall incidence rate in Croatia as 6.5/100,000 children under 18 years. There were 41 boys and 35 girls (ratio 1.17:1). The mean age at diagnosis was 9.7 (range 0.8-16) years and follow-up duration was 5.3 (range 1.8-10) years. Renal colic (75.0 %) and hematuria (57.89 %) were the main symptoms. In 65.78 % of children, stones were unilateral. Stones were located in kidney in 52.63 %, in the ureter in 26.32 %, and in bladder in 6.58 % cases. Stone analysis showed calcium oxalate in 75.0 % of the cases. Associated urinary tract abnormalities were found in 19.73 % children. Most common metabolic disturbances were hypercalciuria (47.37 %) and idiopathic or mild hyperoxaluria (18.42 %). Urine saturation (EQUIL2) was elevated in 61.84 % cases. Spontaneous stone evacuation occurred in 51.21 % children. Extracorporeal shock wave lithotripsy, surgical evacuation, and endoscopic removal of calculi were performed in 21.0, 6.58, and 5.26 % of cases, respectively. Follow-up conservative therapy, consisting of fluid/diet recommendations and additional potassium citrate and/or chlorothiazide in children with increased risk, was sufficient for stone recurrence prevention in 92.1 % of children. In conclusion, the study gave insight in epidemiology and metabolic disturbances of urinary stone disease in Croatian children.
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