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Metabolic Evaluation in Paediatric Urolithiasis: A 4-Year Open Prospective Study
Ajay Kumar R Gajengi1, Vinayak Gorakhnath Wagaskar1, Harshwardhan V Tanwar1
1Senior Resident, Department of Urology, Seth G.S.M.C. and King's Edward Memorial Hospital , Mumbai, Maharashtra, India .
Insights
Low water intake leading to low urine volume is a key factor in childhood urolithiasis. Hypocalcemia is a significant metabolic abnormality, contrasting with prior research, highlighting the need for specific Indian pediatric data.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Urolithiasis in children presents significant morbidity, often linked to underlying metabolic abnormalities.
- Addressing these metabolic issues is crucial for preventing recurrent stone formation.
Purpose of the Study:
- To investigate metabolic risk factors associated with pediatric urolithiasis.
- To compare findings in Indian children with existing international literature.
Main Methods:
- A prospective, observational study evaluated 75 children with urolithiasis from August 2010 to June 2014.
- Data collected included dietary history, water intake, and laboratory findings, with urine samples analyzed without dietary restrictions.
- Standardized pediatric 24-hour urinary parameters from Western literature were used for comparison.
Main Results:
- Low urine volume, observed in 49 patients, suggests increased fluid intake as a primary intervention.
- Low calcium intake was noted in 44 patients, potentially increasing intestinal oxalate absorption and urolithiasis risk.
- Hypocalcemia (32 patients) and 24-hour urinary abnormalities (16 patients) were observed, with findings for hypocalcemia contradicting previous studies.
Conclusions:
- Reduced water intake leading to low urine volume is the predominant finding in pediatric urolithiasis.
- Hypocalcemia represents a major metabolic abnormality in this cohort, diverging from Western literature findings.
- Establishing normative data for urinary excretion of key metabolites in Indian children is essential; maintaining optimal blood calcium and fluid intake may prevent stone formation.
Introduction:
Children with urolithiasis are associated with considerable morbidity and commonly associated with metabolic abnormalities. By treating these abnormalities stone formation is prevented.
Objectives:
To study the metabolic risk factors of urolithiasis in children and compare them with literature.
Materials And Methods:
In open, prospective and observational study, 75 children were evaluated from August 2010 to June 2014. In all patients' dietary history, water intake and results of laboratory findings were recorded. All urine samples obtained from patients were without dietary restrictions. Reference paediatric 24 hour urinary parameter was used according to western literature.
Results:
We investigated 75 patients with urolithiasis. Low urine volume was found in 49 patients which is comparable with previous studies indicating simple intervention as to increase water intake. Low calcium intake was found in 44 patients suggesting that low calcium intake is associated with higher incidence of urolithiasis due to increased intestinal oxalate absorption. Hypocalcaemia was found in 32 patients and 24 hour urinary abnormality was found in only 16 patients'. Both these finding does not support previous literature. Stone analysis finding does not correlate with urinary finding.
Conclusions:
Low urine volume secondary to low water intake is predominant finding. Hypocalcaemia is major metabolic abnormality in contradiction to western literature. There are no nomograms for urinary excretion of Calcium, uric acid, oxalate and citrate in Indian children. Keeping the optimum blood calcium level & increased fluid intake can prevent stone formation in children.
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