Çocuklarda Üriner Taş Hastalığı ve Renal Mikrolitiyazis: Tek Merkezli Bir Çalışma

Öz

Nefrolitiazis, çocuklarda görülme sıklığı giderek artan yaygın bir hastalıktır. Renal mikrolitiazis (ML), üriner ultrasonda 3 mm'den küçük renal hiperekojenik odak olarak tanımlanır. Pediyatrik popülasyonda ML'nin klinik önemi halen tartışmalıdır. Bu çalışma, çocuklarda renal ML ve aşikar nefrolitiazisli çocukların demografik verileri ve metabolik anormalliklerindeki farklılıkları değerlendirdi. İki grup arasında lateralite, taş sayısı, taş çapı, İYE, ağrı ile prezentasyon, rastlantısal olarak saptanan böbrek taşı, idrar yoğunluğu, hiperkalsiüri, spot idrar ürik asit/kreatinin oranı, idrar sodyum/potasyum oranı, ve potasyum sitrat tedavisi alma (p = 0,02, p = 0,03, p<0,001, p = 0,02, p = 0,04, p = 0,01, p = 0,04, p = 0,02, p<0,001, p = 0,03, p = 0,041 ve p = 0.013, sırasıyla) açısından anlamlı fark saptandı. ML, aşikar nefrolitiazisin gelişimindeki ilk basamak olabilir. Bu nedenle, ürolitiazis saptanan tüm hastalar taş boyutuna bakılmaksızın hastalığın komplikasyonlarını önlemek amacı ile takip altına alınmalıdır.

Anahtar Kelimeler

• Çocuk
• mikrolitiyazis
• nefrolitiyazis

Urinary Stone Disease and Renal Microlithiasis In Children: A Single Centre Study

Abstract

defined as a renal hyperechogenic focus smaller than 3 mm in diameter on urinary ultrasound. The clinical importance of ML remains controversial in the pediatric population. The current study evaluated the differences in the demographic data and metabolic abnormalities between children with renal ML and those with overt nephrolithiasis. There were statistically significant differences between the two groups in terms of laterality, number of stones, stone diameter, urinary tract infections, pain at presentation, incidental kidney stones, urine density, hypercalciuria, spot urine uric acid/creatinine ratio, urine sodium/potassium ratio, and potassium citrate therapy (p = 0.02, p = 0.03, p < 0.001, p = 0.02, p = 0.04, p = 0.01, p = 0.04, p = 0.02, p < 0.001, p = 0.03, p = 0.041, and p = 0.013, respectively). ML may be the first stage in the development of overt nephrolithiasis. Therefore, all patients with urolithiasis, regardless of stone size, should be followed up to prevent complications of the disease.

Keywords

• Children
• microlithiasis
• nephrolithiasis

Kaynakça

1. Alpay, H., Ozen, A., Gokce, I., & Biyikli, N. (2009). Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatric Nephrology (Berlin, Germany), 24(11), 2203–2209.
2. Baştuğ, F., & Düşünsel, R. (2012). Pediatric urolithiasis: causative factors, diagnosis and medical management. Nature Reviews Urology, 9(3), 138–146.
3. Bilge, I., Yilmaz, A., Kayiran, S. M., Emre, S., Kadioglu, A., Yekeler, E., Sucu, A., & Sirin, A. (2013). Clinical importance of renal calyceal microlithiasis in children. Pediatrics International: official journal of the Japan Pediatric Society, 55(6), 731–736.
4. Cao, B., Daniel, R., McGregor, R., & Tasian, G. E. (2023). Pediatric Nephrolithiasis. Healthcare (Basel, Switzerland), 11(4), 552.
5. Cirillo, M., Laurenzi, M., Panarelli, W., & Stamler, J. (1994). Urinary sodium to potassium ratio and urinary stone disease. The Gubbio Population Study Research Group. Kidney International, 46(4), 1133–1139. Dinçel, N., Özdemir, K. & Mir, S. (2012). İzmir Bölgesinde Nefrolitiazis İle İzlenen Çocukların Demografik ve Klinik Özellikleri. Çağdaş Tıp Dergisi, 2 (2), 77-81
6. Dursun, I., Poyrazoglu, H. M., Dusunsel, R., Gunduz, Z., Gurgoze, M. K., Demirci, D., & Kucukaydin, M. (2008). Pediatric urolithiasis: an 8-year experience of single centre. International Urology and Nephrology, 40(1), 3–9.
7. Fahimi, D., Habibi Zoham, M., Sheikh, M., Salabati, M., Ghazanfari, A., Firouzi, M., & Honarmand, M. (2016). A Comparison between Clinical and Metabolic Features of Renal Calyceal Microlithiasis and Overt Urolithiasis in Different Pediatric Age Groups. Urologia Internationalis, 96(1), 91–98
8. Fallahzadeh, M. A., Hassanzadeh, J., & Fallahzadeh, M. H. (2016). What do we know about pediatric renal microlithiasis? Journal of Renal Injury Prevention, 6(2), 70–75.

9. Injeyan, M., Bidault, V., Bacchetta, J., & Bertholet-Thomas, A. (2023). Hydration and Nephrolithiasis in Pediatric Populations: Specificities and Current Recommendations. Nutrients, 15(3), 728.
10. Kokorowski, P. J., Hubert, K., & Nelson, C. P. (2010). Evaluation of pediatric nephrolithiasis. Indian Journal of Urology: IJU: journal of the Urological Society of India, 26(4), 531–535
11. La Manna, A., Polito, C., Cioce, F., De Maria, G., Capacchione, A., Rocco, C. E., Papale, M. R., & Romei, L. (1998). Calyceal microlithiasis in children: report on 196 cases. Pediatric nephrology (Berlin, Germany), 12(3), 214–217. Marra, G., Taroni, F., Berrettini, A., Montanari, E., Manzoni, G., & Montini, G. (2019). Pediatric nephrolithiasis: a systematic approach from diagnosis to treatment. Journal of Nephrology, 32(2), 199–210.
12. Önal, B., & Kırlı, E. A. (2021). Pediatric stone disease: Current management and future concepts. Turkish Archives of Pediatrics, 56(2), 99–107.
13. Reusz, G. S., Hosszu, A., & Kis, E. (2020). Evaluation of a child with suspected nephrolithiasis. Current Opinion in Pediatrics, 32(2), 265–272.
14. Sankar Raj, V.M., Ren, J., & Warnecke, D.. (2020). Urinary Sodium to Potassium Ratio in Pediatric Stone Patients. Neonatal. 1(1):02.
15. Stein, R., Dogan, H. S., Hoebeke, P., Kočvara, R., Nijman, R. J., Radmayr, C., Tekgül, S. (2015). European Association of Urology, & European Society for Pediatric Urology (2015). Urinary tract infections in children: EAU/ESPU guidelines. European Urology, 67(3), 546–558.
16. Taşdemir, M. (2017). Metabolic abnormalities in children with urinary stone disease and the influence of gender. The Medical Bulletin of Sisli Etfal Hospital, 51(3): 218-224.
17. Unno, R., Taguchi, K., Okada, A., Ando, R., Hamamoto, S., Kubota, Y., Zuo, L., Tozawa, K., Kohri, K., & Yasui, T. (2017). Potassium-sodium citrate prevents the development of renal microcalculi into symptomatic stones in calcium stone-forming patients. International Journal of Urology: official journal of the Japanese Urological Association, 24(1), 75–81.
18. Yilmaz, K., & Dorterler, M. (2020) Characteristics of Presentation and Metabolic Risk Factors in Relation to Extent of Involvement in Infants with Nephrolithiasis. Eurasian Journal of Medical Investigation, 4(1): 78-85
19. Yüksel, S., Elçi, H. T., Koçyiğit, A., Deniz, M., Becerir, T. & Evrengül, H. (2015). Metabolic risk factors in children with urolithiasis: Single centre experience in southwest Turkey. Pamukkale Medical Journal, (1), 11-17.