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Effect of age, BMI, and gender on urinary risk factors in pediatric idiopathic stone formers
Andrew M Fang1, Elena Gibson2, Robert A Oster1
1University of Alabama at Birmingham, AL, USA.
Insights
Pediatric urolithiasis risk factors vary by age, weight, and gender. Younger, non-overweight, and female children show more urinary risk factors, challenging previous assumptions about stone disease in pediatrics.
Area of Science:
- Pediatric Nephrology
- Urology
- Stone Disease Pathophysiology
Background:
- Pediatric urolithiasis incidence is rising, but etiology remains unclear.
- Previous studies show inconsistent associations between age, BMI, and gender with stone disease.
- Understanding urine chemistry is crucial for pediatric stone disease etiology.
Purpose of the Study:
- Investigate urine chemistry factors in pediatric stone formers.
- Analyze 24-hour urinary parameters stratified by age, BMI, and gender.
- Identify risk factors in a high-volume US Southeast tertiary referral center.
Main Methods:
- Retrospective review of pediatric stone formers (2005-2016).
- Stratification by age (3-10 vs. 11-18 years), overweight status (BMI >85th percentile), and gender.
- Statistical analysis using ANOVA and logistic regression.
Main Results:
- Younger children (3-10 years) had more urinary risk factors than older children.
- Non-overweight patients showed hyperoxaluria and hyperuricosuria; overweight patients had hypocitraturia.
- Female patients had higher hyperoxaluria; male patients had higher hypercalciuria.
Conclusions:
- Obesity is not linked to increased urolithiasis risk; non-overweight children had more risk factors.
- Younger children and females exhibited more urinary risk factors.
- Further research is needed to understand pediatric stone disease risk factors and pathophysiology.
Introduction:
The incidence of pediatric urolithiasis has been increasing over the years; however, the etiology of this increase is not well understood. Age, body mass index, and gender have been examined as possible risk factors for stone disease, but with inconsistent and variable associations.
Objective:
We aim to investigate the urine chemistry factors, as assessed by 24-h urinary parameters, in pediatric stone formers at a large volume tertiary referral center in the highest areas in the United States, the Southeast, based on age, body mass index, and gender.
Study Design:
We retrospectively reviewed all pediatric stone formers who completed a 24-h study between 2005 and 2016. Patients were stratified by age (3-10 versus 11-18 years of age), overweight status (above versus below the 85th percentile for body mass index), and gender (male versus female) (Summary Figure). Statistical analysis included analysis of variance and logistic regression.
Results:
243 patients were included in our analysis. Patients in the first decade of life were found to have greater numbers of urinary risk factors than those in the second decade. Non-overweight patients were more likely to have hyperoxaluria and hyperuricosuria, while overweight patients were more likely to have hypocitraturia. Female patients were more likely to have higher hyperoxaluria, while male patients were more likely to have hypercalciuria.
Discussion:
In contrast to prior publications, obesity is not linked to increased risk of urolithiasis with non-overweight individuals having a greater number of risk factors than the overweight cohort. Despite stone disease being more prevalent in adolescents, the greatest number of risk factors were present in the first decade of life. Lastly, female children had more urinary risk factors than males. Further understanding of the underlying causes of stone disease in various pediatric populations is warranted.
Conclusion:
While more urinary risk factors were identified in younger, non-overweight, and female patients, there remains no consensus on the urinary risk factors for pediatric urolithiasis. Further study is needed to elucidate the risk factors and pathophysiology of pediatric stone disease.
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