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[Urinary lithiasis after kidney transplantation. Experience at a pediatric center]
1Service de Néphrologie Pédiatrique, Hôpital des Enfants-Malades, Paris.
Insights
Urolithiasis (kidney stones) affects 5% of pediatric renal transplant recipients. Key risk factors include urinary infections and metabolic changes, necessitating regular imaging for early detection and prevention.
Area of Science:
- Nephrology
- Urology
- Pediatric Surgery
Context:
- Urologic complications, including urolithiasis, are significant challenges in pediatric renal transplant recipients.
- Identifying risk factors for urolithiasis is crucial for improving patient outcomes.
Purpose:
- To retrospectively analyze the incidence and risk factors of urolithiasis in children and adolescents undergoing renal transplantation.
Summary:
- A retrospective analysis of 652 renal transplantations identified urolithiasis in 5% of patients.
- Identified risk factors included ureteral reimplantation into intestinal bladders, nonresorbable sutures, recurrent urinary infections, hypercalciuria, and hyperparathyroidism.
- Symptoms commonly included hematuria and dysuria, with 13 cases leading to urinary obstruction requiring surgery in 9 patients. Renal function remained unaffected.
Impact:
- Findings highlight the importance of preventing urinary infections and managing metabolic factors like calcium and phosphorus metabolism.
- Regular imaging during follow-up is essential for early diagnosis and management of urolithiasis in this vulnerable population.
Background:
Urologic complications are still a frequent and significant problem in renal transplant recipients. The search for risk factors is therefore mandatory.
Material And Methods:
652 renal transplantations were performed in children and adolescents between January 1973 and December 1988. 33 patients (5%) developed urolithiasis; their files were retrospectively analysed at the same time as the files of 28 patients transplanted during the same period and having similar ages, reasons for transplantation and immunosuppressive therapy.
Results:
The stones contained calcium in 27 patients and uric acid in 6. The first symptoms were hematuria (27 times) with or without dysuria (9 cases), urine retention (2 cases) and anuria (2 cases). Repeated urine infections frequently led to the use of imaging techniques that permitted diagnosis. Urolithiasis was responsible for urinary obstruction in 13 cases; 9 of these required surgery. The course was always good without any modification of renal functions. The main risk factors were local: ureteral reimplantation on intestinal bladder, use of nonresorbable stitches and repeated urinary infections. Metabolic factors were less frequent and included hypercalciuria (18 cases) and hyperparathyroidism (2 cases).
Conclusions:
Some of the risk factors such as urinary infections, changes in the metabolism of phosphorus and calcium or insufficient diuresis, can be prevented. Repeated imaging techniques during the follow-up are mandatory.