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[Metabolic etiology of urinary calculi in children]
Insights
Pediatric urolithiasis is often linked to urinary tract infections, particularly those caused by urease-producing bacteria like Proteus. Phosphates are the most common urinary stone compound in children, unlike adults where calcium oxalate predominates.
Area of Science:
- Pediatric Nephrology
- Urology
- Microbiology
Context:
- A retrospective analysis of 100 children diagnosed with urolithiasis between 1976 and 1978.
- The study included patients aged 3 months to 18 years, with a near-equal gender distribution (51 boys, 49 girls).
- This research provides a historical perspective on pediatric urolithiasis before significant advancements in diagnostic and treatment modalities.
Purpose:
- To investigate the causes, characteristics, and etiological factors of urolithiasis in a pediatric population.
- To identify common bacterial strains, urinary tract obstruction prevalence, and the chemical composition of urinary stones in children.
- To determine the proportion of metabolic, infectious, and idiopathic causes of pediatric urolithiasis.
Summary:
- Urinary tract infections (UTIs) were prevalent in 57.4% of cases, with urease-producing bacteria (e.g., Proteus) identified in 88.9% of infected children.
- Urinary tract obstruction was noted in 36% of patients, and upper urinary tract stones were most common (77%).
- Phosphate stones were the predominant composition (58.4%) in children, contrasting with calcium oxalate in adults. Metabolic causes were identified in 26% of cases, including idiopathic hypercalciuria and uric acid urolithiasis.
Impact:
- Highlights the significant role of UTIs and specific bacterial profiles in pediatric urolithiasis.
- Underscores the difference in urinary stone composition between pediatric and adult populations.
- Provides foundational data for understanding the multifactorial etiology of urolithiasis in children, aiding in early diagnosis and management strategies.
Abstract:
The analysed material includes 100 children with urolithiasis treated in the Pediatric Clinic of the National Research Institute of Mother and Child in Warsaw between 1976 and 1978. Patients' age was from 3 months to 18 years. The analysed group included 51 boys and 49 girls. Urinary tract infection was found in 54 cases, i.e. 57,4% of the analysed material. The most common bacterial strains were those producing urease. They were detected in 48 children i.e. 88,9% of cases with urinary tract infection. Mostly these were bacteria of Proteus group--sporadically Pseudomonas aeruginosa and Staphylococcus albus. In the analysed patients urinary tract obstruction was observed in 36 children, i.e. 36% of cases. In 77% of the analysed material, localization of concrements was in upper urinary tract in 19% in the ureters and in 4% in the lover urinary tract. While in adult patients the most common compound of urinary stones was calcium oxalate, in children the most common stone compounds were phosphates (found in 38 cases i.e. 58,4% of the analysed material). The second frequent compound was oxalate found in 20 cases (30,7%). Less frequent compounds were uric acid and cystine. Performed study allowed to establish the cause of urolithiasis in 93 out of 100 examined children. Metabolic reasons of urolithiasis were found in 26 cases, i.e. 26% of the analysed material. They were as follows: idiopathic hypercalciuria--12 cases, uric acid urolithiasis--8 cases, primary hyperoxaluria--3 cases, cystinuria--2 cases, and incomplete acidosis of distal renal tubuli--1 case. Urolithiasis of probably metabolic origin was detected in 13 children (13%). Other reasons of urolithiasis in children were: infection (31%), idiopathic urolithiasis (17%) and others (6%). In 7 cases the reason of urolithiasis was not established.