Why we need a higher suspicion index of urolithiasis in children

Area of Science:

• Pediatric Nephrology
• Pediatric Urology
• Diagnostic Imaging

Background:

• Many children present with urolithiasis symptoms but lack detectable stones on initial imaging (occult urolithiasis).
• Common symptoms include abdominal pain, hematuria, and dysuria, often managed by general pediatricians.
• Abdominal or flank pain, even without urinary symptoms, can indicate urolithiasis in over half of pediatric cases.

Purpose of the Study:

• To review evidence on the prevalence, clinical presentation, and radiological detection of overt and occult urolithiasis in children.
• To equip clinicians with tools to suspect and diagnose pediatric urolithiasis effectively.
• To guide against cost-ineffective and unnecessary diagnostic procedures.

Main Methods:

• Systematic review of current evidence on pediatric urolithiasis.
• Analysis of prevalence, clinical presentation, and radiological detection methods.
• Focus on differentiating overt and occult urolithiasis.

Main Results:

• Ultrasound is the primary imaging modality for investigating pediatric urolithiasis.
• Specific clinical groups warrant further investigation, including those with non-glomerular hematuria/dysuria, recurrent abdominal pain with family history, young children with diffuse pain, and those with predisposing risk factors.
• Repeat ultrasounds may be beneficial for children with occult urolithiasis and high stone development risk.

Conclusions:

• Investigate pediatric urolithiasis using ultrasound, supplemented by metabolic and advanced imaging when indicated.
• Targeted investigation is crucial for children with specific symptoms, family history, or risk factors.
• Follow-up imaging is recommended for high-risk children with occult urolithiasis to monitor for stone recurrence.