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Epidemiology of paediatric renal stone disease: a 22-year single centre experience in the UK
Naomi Issler1,2, Stephanie Dufek1,2, Robert Kleta1,3,2
1Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
Insights
Paediatric kidney stone disease is increasingly common, with most cases linked to metabolic or infectious causes. Early diagnosis and treatment are crucial for preventing recurrence in children.
Area of Science:
- Urology
- Nephrology
- Pediatrics
Background:
- Paediatric kidney stone disease incidence is rising in developed nations.
- A dedicated pediatric renal stone service was established in 1993.
- A large case series allows for epidemiological investigation.
Purpose of the Study:
- To investigate the epidemiology of paediatric kidney stone disease.
- To identify underlying causes and risk factors.
- To analyze clinical and laboratory data from a large cohort.
Main Methods:
- Retrospective review of pediatric kidney stone cases from 1993-2015.
- Comprehensive infective and metabolic screening for all patients.
- Classification of stones into metabolic, infective, or idiopathic categories.
Main Results:
- 511 children reviewed; median age 4.4y (males) and 7.3y (females).
- 34% had metabolic abnormalities (hypercalciuria, hyperoxaluria, cystinuria), 22% infective, 44% idiopathic.
- Metabolic stones were associated with bilateral occurrence and urinary tract infections.
Conclusions:
- Presents the largest pediatric stone disease cohort from a developed country.
- Highlights the importance of identifying metabolic and/or infective etiologies for treatment and prevention.
- Paediatric stone disease is not associated with obesity, unlike in adults.
Background:
Whilst still rare, the incidence of paediatric stone disease is increasing in developed countries and it is important to evaluate the aetiology. We set up a dedicated renal stone service for children combining medical and surgical expertise in 1993 and now have a large case series of children to investigate the epidemiology.
Methods:
A retrospective hospital note review of children presenting with kidney stones during the last 22 years (1993-2015) was conducted. All patients had a comprehensive infective and metabolic screen and were classified as metabolic, infective or idiopathic stone disease.
Results:
Five hundred eleven patients (322 male) were reviewed. The median age of presentation was 4.4y for males (1 m-16.6y) and 7.3y (1-18.5y) for females with a median height and weight on the 25th centile for male and on 10th and 25th for female, respectively. One hundred seventy five (34%) had an underlying metabolic abnormality, 112 (22%) had infective stones and 224 (44%) were classified as idiopathic. Of the 175 patients with a metabolic abnormality: 91 (52%) had hypercalciuria (76 persistent and 15 transient), 37 (21%) hyperoxaluria, 38 (22%) cystinuria, 3 (2%) abnormalities in the purine metabolism and the remainder other metabolic abnormalities. Bilateral stones occurred in 27% of the metabolic group compared to 16% in the non-metabolic group (OR 0.2, p < 0.05). Urinary tract infection was a common complication (27%) in the metabolic group.
Conclusions:
In this paper, we present the largest cohort of paediatric stone disease reported from a developed country giving details on both, clinical and laboratory data. We show that in the majority of the patients there is an identifiable underlying metabolic and/or infective aetiology emphasizing the importance of a full work up to provide adequate treatment and prevent recurrence. Moreover, we show that stone disease in children, in contrast to the adult population, does not seem to be associated with obesity, as children have a weight below average at presentation.
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