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Unusual aspects of urinary calculi in children
Insights
Urinary calculi are uncommon in US children, with predisposing factors identified in most cases. Management requires caution, especially for lower ureteral stones, and preventive measures like dietary changes and hydration are key for immobilized children.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Nephrology
Background:
- Urinary calculous disease is rare in pediatric populations in the United States.
- A study reviewed 35 children treated for urinary calculi between 1972 and 1977.
Purpose of the Study:
- To identify predisposing factors for urinary stone formation in children.
- To evaluate the effectiveness of metabolic screening in pediatric urinary calculi.
- To outline management strategies for pediatric urinary calculi.
Main Methods:
- Retrospective review of 35 pediatric patients with urinary calculi.
- Identification of predisposing factors in 20 patients.
- Evaluation of metabolic screening results.
Main Results:
- Predisposing factors were identified in 20 of the 35 children.
- Metabolic screening was largely unrewarding for identifying causes.
- Identified contributing factors included obstructive uropathy, immobilization, urinary stasis, infection, urologic anomalies, steroid therapy, milk-alkali syndrome, iatrogenic, and endemic diseases.
Conclusions:
- Urinary calculi in children can result from various factors beyond metabolic abnormalities.
- Management principles are similar to adults but require specific precautions for transurethral procedures.
- Preventive strategies like dietary modification, hydration, and position changes are crucial for immobilized children.
Abstract:
Urinary calculous disease is unusual in children in the United States. During the last 5 years (1972 to 1977) we have examined and treated 35 children with urinary calculi. The predisposing factors to calculus formation have been established in 20 children. Metabolic screening, although mandatory, has proved unrewarding in the evaluation of children with urinary calculi. Obstructive uropathy, immobilization, urinary stasis and infection, previously undiagnosed urologic anomalies, steroid therapy, milk-alkali syndrome, iatrogenic disease and endemic disease have contributed to stone formation. The management of children with urinary calculi generally parallels that of adults but reflects a need for caution when performing transurethral extraction of lower ureteral calculi. Reduction in dairy product intake, fluid diuresis and frequent changes in position may provide adequate prophylaxis against urinary calculi in children who must be immobilized.