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Why is childhood urolithiasis increasing? Etiology, diagnosis and management: a single-center experience
Gunes Isik1, Pınar Gundogan Bozdag2
1Pediatric Nephrology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey. drgunes07@hotmail.com.
Insights
High-dose Vitamin D supplementation may increase kidney stone risk in children. Early intervention with potassium citrate and hydration is key for prevention and treatment of pediatric urolithiasis.
Area of Science:
- Pediatric Nephrology
- Urology
- Metabolic Disorders
Background:
- Urolithiasis (kidney stones) is a growing global health concern in pediatric populations.
- Understanding the underlying causes and effective management strategies is crucial for this age group.
Purpose of the Study:
- To investigate the etiological factors contributing to urolithiasis in children.
- To analyze the diagnostic and therapeutic approaches employed in pediatric urolithiasis cases.
Main Methods:
- A retrospective study of 197 pediatric patients (1 month-18 years) diagnosed with urolithiasis via ultrasonography.
- Exclusion of patients with predisposing chronic diseases.
- Collection of demographic data, serum/urine biochemistry, metabolic screening, and treatment details.
Main Results:
- Hypercalciuria (35%), hypocitraturia (20%), and hyperoxaluria (8%) were common metabolic abnormalities.
- A positive family history of kidney stones was noted in 42% of patients.
- Vitamin D supplementation exceeding 400 IU/day was identified as a potential risk factor.
Conclusions:
- Excessive Vitamin D intake may elevate the risk of kidney stones in children.
- Inadequate fluid intake in infants is a contributing factor.
- Potassium citrate is effective for stone prevention and dissolution through urine alkalinization.
Background:
Globally, urolithiasis is becoming more and more common among children. We aimed to determine the etiology, and the diagnostic and therapeutic approaches in patients with urolithiasis.
Methods:
This was a retrospective study which included all patients (aged 1 month-18 years) admitted to the pediatric nephrology clinic in Elazığ Fethi Sekin City Hospital with urolithiasis between November 2019 and 2021. Only patients whose diagnosis of urolithiasis was confirmed by urinary ultrasonography were included in the study, while patients with chronic diseases (neurological diseases such as epilepsy, cerebral palsy, chronic bowel diseases, etc.) predisposing to kidney stone formation were not. Demographic characteristics, serum and urine biochemical parameters, urine metabolic and kidney stone metabolic and chemical analyses, urinary tract ultrasonography findings and treatment modalities were collected.
Results:
One hundred ninety-seven patients (91 female and 106 male) were included in the study. Hypervitaminosis D was detected in 4 (2%) patients, suppressed parathyroid hormone in 12 (6%) and hypercalcemia in 27 (14%) patients. Metabolic screening showed hypercalciuria in 69 (35%) patients, hypocitraturia in 39 (20%), hyperoxaluria in 15 (8%) and cystinuria in 6 (3%) patients. Eighty three (42%) patients had a positive family history for kidney stones. One hundred eighteen (60%) patients received potassium citrate treatment, 71 (36%) were given hydration and diet recommendations without medical treatment, 6 (3%) received tiopronin treatment, and 2 (1%) patients were treated surgically.
Conclusions:
Our study suggests that Vitamin D supplementation at doses higher than 400 IU/day may be a risk factor for kidney stones in children. We observed that mothers tend not to give water to infants who are breastfed or formula-fed in the first year of life. K-citrate treatment can be a good option for prevention and dissolution of stones by alkalinization.
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