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Metabolic evaluation in paediatric urolithiasis: Is a key component being overlooked? An international survey by the
Y Quiroz Madarriaga1, M I Dönmez2, R J M Lammers3
1Unidad de Urología Pediátrica, Fundación Puigvert, Barcelona, Spain.
Insights
Paediatric urolithiasis is rising globally. Metabolic evaluations for pediatric kidney stones are inconsistent, with limited urologist involvement and a need for standardized guidelines and education.
Area of Science:
- Pediatric Urology
- Nephrology
- Metabolic Disorders
Background:
- Paediatric urolithiasis incidence is increasing worldwide.
- Metabolic abnormalities are a significant factor in pediatric kidney stone formation.
- Standardized protocols for metabolic evaluation in children with urolithiasis are currently lacking.
Purpose of the Study:
- To assess current practices and knowledge regarding metabolic evaluation of paediatric urolithiasis among pediatric urologists globally.
- To identify gaps in current diagnostic and treatment strategies for pediatric kidney stone disease.
Main Methods:
- An international survey was conducted among pediatric urologists.
- Data collected included clinician demographics and metabolic evaluation strategies for pediatric stone disease.
- Responses were gathered from 194 clinicians across 49 countries.
Main Results:
- Only 11% of clinicians routinely performed metabolic evaluations for pediatric urolithiasis.
- While 78% requested stone analysis, only 46% ordered 24-hour urine studies.
- Paediatric nephrologists managed evaluations in 84% of cases, with limited urologist involvement (<25%).
- Knowledge of spot urine indices and crystalluria as a risk factor was varied (55% recognized crystalluria).
- Fewer than one-third of urologists felt confident interpreting results or initiating treatment.
Conclusions:
- Significant inconsistencies exist in the metabolic evaluation of paediatric urolithiasis.
- There is a need for clearer guidelines and enhanced education for pediatric urologists.
- Increased urologist involvement is crucial for improving metabolic assessment and management of pediatric kidney stones.
Abstract:
Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-h urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.
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