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A Comparison between Clinical and Metabolic Features of Renal Calyceal Microlithiasis and Overt Urolithiasis in
Daryoosh Fahimi1, Mojdeh Habibi Zoham, Mahdi Sheikh
1Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran, Iran.
Insights
Children with kidney stones often have metabolic issues that vary by age. Overt urolithiasis, unlike renal calyceal microlithiasis, presents with more complications, especially in younger children.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Renal calyceal microlithiasis (RCM) and overt urolithiasis are common in children.
- Understanding differences in presentation, complications, and metabolic abnormalities is crucial for effective management.
Purpose of the Study:
- To compare pediatric renal calyceal microlithiasis (RCM) and overt urolithiasis.
- To analyze age-specific differences in clinical presentations, complications, and metabolic abnormalities.
Main Methods:
- Retrospective analysis of 465 children with urolithiasis.
- Categorization into age groups: infancy, early childhood, middle childhood, and adolescence.
- Definition of RCM (<3 mm) and overt urolithiasis (≥3 mm) based on ultrasound findings.
Main Results:
- Metabolic abnormalities found in 71% of patients, varying by age (hyperuricosuria, hyperoxaluria, hypocitraturia).
- Hypercalciuria significantly associated with overt urolithiasis across all pediatric ages (OR 2.25).
- Overt urolithiasis showed significantly higher rates of complications, including urinary tract infections and growth retardation, particularly in infants and younger children.
Conclusions:
- Pediatric urolithiasis is frequently linked to age-dependent metabolic abnormalities.
- Hypercalciuria is a consistent risk factor for overt urolithiasis in children.
- While clinical features don't distinguish RCM from overt urolithiasis, complications are more prevalent in overt cases, necessitating prompt diagnosis and management.
Introduction:
This study assesses the differences in the presentations, complications and metabolic abnormalities of children with renal calyceal microlithiasis (RCM) and overt urolithiasis in different pediatric ages.
Materials And Methods:
A total of 465 children with urolithiasis were investigated retrospectively. Patients were categorized based on their ages to infancy, early childhood, middle childhood and adolescence. When the hyperechogenic spots on ultrasound imaging were <3 mm, they were considered RCM, and if they were ≥3 mm, they were considered overt urolithiasis.
Results:
Metabolic abnormalities were detected in 71%; hyperuricosuria in infants, hyperoxaluria in younger children and hypocitraturia in older children were the most common metabolic abnormalities. Hypercalciuria was the only metabolic abnormality that was significantly associated with overt urolithiasis in all pediatric ages (OR 2.25, 95% CI 1.21-4.19). The clinical presentations were not significantly different between RCM and overt urolithiasis; however, complications such as urinary tract infection was significantly higher with overt urolithiasis in infancy (p = 0.01), early childhood (p = 0.02), middle childhood (p = 0.007) and adolescence (p = 0.01). Also, growth retardation was significantly higher with overt urolithiasis in infancy and early childhood (p = 0.02).
Conclusions:
Most children with urolithiasis have underlying urinary metabolic abnormalities that differ according to the child's age. Despite these differences, hypercalciuria is significantly associated with overt urolithiasis in all pediatric ages. Clinical and laboratory features cannot differentiate RCM and overt urolithiasis; however, complications are significantly higher with overt urolithiasis.
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