Long-Term Follow-up Results of Children with Urolithiasis Followed in Our Clinic

Abstract

Title and Objective: Urolithiasis is a prevalent condition frequently observed in childhood within the Turkish population. The aim of this study was to evaluate the metabolic, radiological, and clinical features of pediatric patients with urolithiasis. Materials and Methods: Records of 158 children referred to the Pediatric Nephrology Department of Celal Bayar University between 2010 and 2020 with suspected urolithiasis and microlithiasis were retrospectively reviewed. The complaints and ages of the cases during hospital admission, their medical histories, and the location of the stones were determined. All patients underwent complete urine analysis, spot urine electrolytes, urine culture, serum electrolytes, kidney function tests, uric acid, albumin measurements, and urinary ultrasonography. 24-hour urine electrolytes were studied in patients capable of urine collection. Stone analysis using X-ray diffraction was performed on patients from whom stones were obtained. Results: Out of the individuals, 88 (55.7%) were male, and 70 (44.3%) were female, resulting in a male-to-female ratio of 1.25:1. The average age at the time of diagnosis was determined to be 89.82 ± 57.35 months. A family history of urolithiasis was reported in 108 (68.3%) patients, and 46 individuals (29%) were born from consanguineous marriages. At the time of diagnosis, 32 patients (20%) had a urinary tract infection. Stones were predominantly situated in the upper urinary system in 129 patients (81.6%), with 123 (77.8%) having unilateral stones and 35 (22.2%) having bilateral stones. Calcium oxalate stones were the most commonly observed (80%) in patients who underwent stone analysis. Hypercalciuria emerged as the most frequently identified urinary metabolic risk factor. At the end of the follow-up period, 14 patients experienced a recurrence, while 67 patients remained free of stones. Conclusion: Urolithiasis continues to be a significant concern among children in our nation. Due to the higher recurrence rate and more frequent underlying metabolic disorders in children with stone diseases compared to adults, metabolic assessment and stone analysis are recommended procedures, emphasizing the need for lifelong monitoring in these cases.

Keywords

• child
• urolithiasis
• microlithiasis
• metabolic risk factors

Supporting Institution

This research did not receive any financial support from public, commercial, or non-profit sectors.

Ethical Statement

Our study was conducted in compliance with the Helsinki Declaration principles and obtained ethical approval from the Celal Bayar University Faculty of Medicine Clinical Research Ethics Committee on November 24, 2021, with protocol number 20.478.486.

Long-Term Follow-up Results of Children with Urolithiasis Followed in Our Clinic

Abstract

Giriş ve Amaç: Ürolitiyazis, Türkiye'de çocuklarda sık rastlanan bir hastalıktır. Bu çalışmada, ürolitiyazisli çocukların klinik, radyolojik ve metabolik özellikleri üzerine bir değerlendirme yapılmıştır. Gereç ve Yöntemler: 2010 ile 2020 yılları arasında Celal Bayar Üniversitesi Pediatrik Nefroloji Anabilim Dalı'na ürolitiyazis ve mikrolitiyazis şüphesiyle sevk edilen 158 çocuğun kayıtları geriye dönük tarandı. Olguların hastaneye başvurudaki şikayetleri ve yaşları, özgeçmiş öyküleri ve taşların lokasyonu belirlendi. Tüm hastalardan tam idrar tetkiki, spot idrar elektrolitleri, idrar kültürü, serum elektrolitleri, böbrek fonksiyon testleri, ürik asit, albümin ölçümleri ve üriner ultrasonografi istenildi. İdrar toplayabilen hastalarda 24 saatlik idrar elektrolitleri çalışıldı. Taş elde edilebilen hastalara X ışını ile difraksiyon yöntemiyle taş analizi yapıldı. Bulgular: Çalışmada yer alan 158 çocuğun 88'i (%55.7) erkek, 70'i (%44.3) kız olup, erkek/kız oranı 1.25/1 olarak belirlendi. Ortalama tanı yaşı 89.82 ± 57.35 ay olarak saptandı. Bu hastaların 108'inde (%68.3) ailede ürolitiyazis öyküsü bulunmaktaydı. Ayrıca, 46 hasta (%29) akraba evliliğinden doğmuştu. Tanı anında 32 hastada (%20) idrar yolu enfeksiyonu tespit edildi. Hastaların 129'unda (%81.6) taşlar üst üriner sistemde bulunuyordu. Bunların 123'ünde (%77.8) taşlar tek taraflı iken, 35'inde (%22.2) bilateral taşlar mevcuttu. Taş analizi yapılan hastaların çoğunda (%80) kalsiyum oksalat taşları bulundu. En yaygın üriner metabolik risk faktörü ise hiperkalsiüri olarak belirlendi. Takip süresince 67 hasta taş hastalığından kurtulurken, 14 hastada nüks gözlendi. Sonuç: Ülkemizde çocuklarda ürolitiazis ciddi bir sorun olarak devam etmektedir. Çocuklarda taş hastalıklarında erişkinlerden farklı olarak yüksek rekürrens oranı ve altta yatan metabolik bozuklukların daha sık olması nedeniyle metabolik değerlendirme ve taş analizi yapılmalı, ömür boyu takip gereği vurgulanmalıdır.

Keywords

• çocuk
• ürolitiyazis
• mikrolitiyazis
• metabolik risk faktöleri

Supporting Institution

Bu araştırma, herhangi bir kamu, ticari veya kar amacı gütmeyen sektörden finansal destek almadı.

Ethical Statement

Çalışmamız, Helsinki Bildirgesi prensiplerine uygun olarak yürütülmüş olup, 24 Kasım 2021 tarihinde Celal Bayar Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu'ndan 20.478.486 protokol numarası ile etik onay alınmıştır.

References

1. 1. El-Reshaid, K, Mughal, H, Kapoor, M, Epidemiological profile, mineral metabolic pattern and crystallographic analysis of urolithiasis in Kuwait, Eur J Epidemiol, 1997;(132)13:229–234.
2. 2. Daudon, M, Jungers, P, Bazin, D, Williams, JC, J, Recurrence rates of urinary calculi according to stone composition and morphology, Urolithiasis, 2018;46:459-70.
3. 3. Ali, S.H, Rifat, U.N, Etiological and clinical patterns of childhood urolithiasis in Iraq, Pediatr Nephrol, 2005;20(10):1453–7.
4. 4. Baştuǧ, F, Düşünsel, R, Pediatric urolithiasis: causative factors, diagnosis and medical management, Nat Rev Urol, 2012;9(3):138–46.
5. 5. Rellum, D.M, Feitz, W.F, Van Herwaarden, A.E, Schreuder, M.F, Pediatric urolithiasis in a non-endemic country: A single center experience from the Netherlands, J Pediatr Urol, 2014;10(1):155–61.
6. 6. Bak, M, Ural, R, Agin, H, Serdaroglu, E, Calkavur, S, The metabolic etiology of urolithiasis in Turkish children, Int Urol Nephrol, 2009;41(3):453–60.
7. 7. Ece, A, Özdemir, E, Gürkan, F, Dokucu, A.I, Akdeniz, O, Characteristics of pediatric urolithiasis in south-east Anatolia, Int J Urol, 2000;7(9):330–4.
8. 8. Dursun, I, Poyrazoglu H.M, Dusunsel, R, Gunduz, Z, Gurgoze, MK, Demirci, D, et al, Pediatric urolithiasis: An 8-year experience of single centre, Int Urol Nephrol, 2008;40(1):3–9.

9. 9. Tabel, Y, Akin, I.M, Tekin, S, Clinical and Demographic Characteristics of Children with Urolithiasis: Single-Center Experience from Eastern Turkey, Urol Int, 2009;83(2):217–21.
10. 10. Ouzounian, J.G, Castro, M.A, Fresquez, M, Al-Sulyman, O.M, Kovacs, B.W, Prognostic significance of antenatally detected fetal pyelectasis, Ultrasound Obstet Gynecol, 1996;7(6):424–8.
11. 11. Sarkissian, A, Babloyan, A, Arikyants, N, Hesse, A, Blau, N, Leumann, E, Pediatric urolithiasis in Armenia: a study of 198 patients observed from 1991 to 1999, Pediatr Nephrol, 2001;16(9):728–32.
12. 12. Elmaci, A.M, Ece, A, Akin, F, Clinical characteristics and metabolic abnormalities in preschool-age children with urolithiasis in southeast Anatolia, J Pediatr Urol, 2014;10(3):495–9.
13. 13. Alpay, H, Ozen, A, Gokce, I, Biyikli, N, Clinical and metabolic features of urolithiasis and microlithiasis in children, Pediatr Nephrol, 2009;24(11):2203–9.
14. 14. Amin Fallahzadeh, M, Hassanzadeh, J, Fallahzadeh, M.H, What do we know about pediatric renal microlithiasis? Nickan Res Inst, 2016;6(2):70–5.
15. 15. Celiksoy MH, Yilmaz A, Aydogan G, Kiyak A, Topal E, Sander S. Metabolic Disorders in Turkish Children with Urolithiasis. Urology. 2015;85(4):909–13.
16. 16. Polito, C., Cioce, F., La Manna, A., Maiello, R., & Di Toro, R. (1999). Renal calyceal microlithiasis: clinical presentation may precede sonographic evidence. Clinical pediatrics, 38(9), 521-524.
17. 17. Ghazali, S, Barratt, T.M, Urinary excretion of calcium and magnesium in children, Arch Dis Child, 1974;49(2):97.
18. 18. VanDervoort, K, Wiesen, J, Frank, R, Vento, S, Crosby, V, Chandra, M, et al, Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome, J Urol, 2007;177:2300– 5.
19. 19. Spivacow, F.R, Negri, A.L, del Valle, E.E, Calviño, I, Fradinger, E, Zanchetta, J.R, Metabolic risk factors in children with kidney stone disease, Pediatr Nephrol, 2008;23(7):1129–33.
20. 20. Hoppe, B, Beck, B.B, Milliner, D.S, The primary hyperoxalurias, Kidney Int, 2009;75,1264–71.
21. 21. Sas, D.J, An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease, Clin J Am Soc Nephrol, 2011;6(8):2062–8.
22. 22. Soucie, J.M, Coates, R.J, McClellan, W, Austin, H, Thun, M, Relation between geographic variability in kidney stones prevalence and risk factors for stones, Am J Epidemiol, 1996;143(5):487–95.
23. 23. Choi, H, Snyder, H.M, Duckett, J.W, Urolithiasis in childhood: current management, J Pediatr Surg, 1987;22(2):158–64.
24. 24. Malek, R.S, Kelalis, P.P, Pediatric Nephrolithiasis, J Urol, 1975 Apr 1;113(4):545–51.
25. 25. Ghazali, S, Barratt, T.M, Williams, D.I, Childhood urolithiasis in Britain, Arch Dis Child, 1973;48(4):291.
26. 26. Ozokutan, B.H, Küçükaydın, M, Gunduz, Z, Kabaklioglu, M, Okur, H, Turan, C. Urolithiasis in childhood, Pediatric Surgery International, 2000;16, 60-63.
27. 27. Curhan, G.C, Willett, W.C, Rimm, E.B, Stampfer, M.J, Family history and risk of kidney stones, J Am Soc Nephrol, 1997;8(10):1568–73.
28. 28. Elmacı, A.M, Ece, A, Akın, F, Pediatric urolithiasis: metabolic risk factors and follow-up results in a Turkish region with endemic stone disease, Urolithiasis, 2014;42(5):421–6.
29. 29. Androulakakis, P.A, Michael, V, Polychronopoulou, S, Aghioutantis, C, Paediatric urolithiasis in Greece, Br J Urol, 1991;67(2):206–9.
30. 30. Kroovand, R.L, Pediatric urolithiasis, Urol Clin North Am, 1997;24(1):173–84.
31. 31. Kalorin, C.M, Zabinski, A, Okpareke, I, White, M, Kogan, B.A, Pediatric urinary stone disease-does age matter? J Urol, 2009;181(5):2267–71.
32. 32. Ertan, P, Tekin, G, Oger, N, Alkan, S, Horasan, G.D, Metabolic and demographic characteristics of children with urolithiasis in Western Turkey, Urol Res, 2011;39(2):105–10.
33. 33. Knoll, T, Zöllner, A, Wendt-Nordahl, G, Michel, M.S, Alken, P, Cystinuria in childhood and adolescence: Recommendations for diagnosis, treatment, and follow-up, Pediatr Nephrol, 2005;20(1):19–24.
34. 34. Cameron, M.A, Sakhaee, K, Moe, O.W, Nephrolithiasis in children, Pediatr Nephrol, 2005;20:1587–92.
35. 35. Bastug, F, Agbas, A, Tulpar, S, Yıldırım, Z.N.Y, Cicek, N, Gunay, N et al, Comparison of infants and children with urolithiasis: a large case series, Urolithiasis, 2022; 50:411–421