Urinary stone disease in pediatric patients: a mixed-methods study

Yıl 2024, Cilt: 7 Sayı: 6, 681 - 690, 27.10.2024

Hülya Gözde Önal , Yonca Semet

https://doi.org/10.32322/jhsm.1535214

Öz

Aims: Childhood urinary stone disease (USSD) varies in frequency based on several factors such as, gender, age, body mass index, geography, diet, genetic disorders, and kidney anatomy. This study aims to retrospectively evaluate the demographic and clinical characteristics, symptoms, diagnostic methods, predisposing factors, associated urinary system anomalies, treatments, and prognosis of patients diagnosed with USSD in our clinic over the past three years.
Methods: This mixed-methods study retrospectively examined the records of 175 patients diagnosed with USSD between April 2020 and May 2023. Demographic data, symptoms, laboratory results, imaging findings, and treatment outcomes were analyzed. Additionally, qualitative data were gathered from semi-structured interviews with 10 volunteer participants to understand the impact of symptoms on their lives.
Results: Among the 175 pediatric patients diagnosed with urolithiasis, 120 (68.5%) were symptomatic, with common complaints such as irritability (29.1%), pain (18.2%), vomiting (23.4%), and macroscopic hematuria (20%). Significant differences were observed in symptoms based on age and stone size, with older children more likely to experience pain and hematuria, while younger children showed more irritability (p<0.01). Metabolic disorders were present in 78.8% of cases, with hypercalciuria being the most frequent. Qualitative data revealed significant emotional and social challenges. Children expressed fear, anxiety, and embarrassment due to symptoms like pain and bedwetting. These experiences impacted their daily lives, disrupting sleep, play, and social interactions. Family support played a crucial role in managing these emotional burdens, though peer interactions often exacerbated feelings of isolation and discomfort.
Conclusion: The study highlights the critical importance of early diagnosis and individualized treatment strategies in managing pediatric urolithiasis to prevent long-term complications like end-stage renal failure. Presenting symptoms and treatment outcomes are significantly influenced by factors such as age, stone size, and metabolic risk factors. Medical treatment remains the primary approach, while surgical interventions are reserved for complex cases. The findings emphasize the need for personalized management plans, particularly for high-risk children with family history or consanguineous marriages, and underscore the emotional and social challenges these children face.

Anahtar Kelimeler

Childhood urinary stone disease, USSD, demographics and clinical characteristics, symptoms, metabolic risk factors

Kaynakça

• Elder JS. Urinary lithiasis. In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders. 2008;2267-2272.
• Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. In: EAU guidelines. Edition presented at the 16th EAU Congress, Geneva, Switzerland.2001(ISBN 90-806179-3-9).
• Modlin M. A history of urinary stone. S Afr Med J. 1980;58:652-655.
• Chen L, Zhang J, Shen K, et al. Kidney stones are associated with metabolic syndrome in a health screening population: a cross-sectional study. Transl Androl Urol. 2023;12(6):967.
• Demirtaş F, Çakar N, Özçakar ZB, et al. Risk factors for recurrence in pediatric urinary stone disease. Pediatr Nephrol. 2024;1-9.
• Xu Z, Yao X, Duan C, Liu H, Xu H. Metabolic changes in kidney stone disease. Front Immunol. 2023;14:1142207.
• Taner S, Panahlı K, Ünal A, Ekberli G, Tolunay O. The effect of obesity on metabolic risk factors in children with urinary stones. Pediatr Pract Res. 2023;11(3):101-106.
• Öner N, Baştuğ F, Özkan B, Özçatal M, Karakükçü Ç. Urolithiasis in children; the importance of stone localization in treatment and follow-up. Urolithiasis. 2024;52(1):17.
• Curhan GC, Rimm EB, Willet WC, Stampfer MJ. Regional variation in nephrolithiasis incidence and prevalence among United States men. J Urol. 1994;151:838-841.
• Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. Demographic and geographic variability of kidney stones in the United States. Kidney Int. 1994;46:893-899.
• Cameron MA, Sakhae K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol, 2005; 20:1587-1592.
• Smaldone MC, Corcoran AT, Docimo SG, Ost MC. Endourological management of pediatric stone disease: present status. J Urol. 2009;181:17-28.
• Faerber G J. Pediatric urolithiasis. Current Opinion in Urology. 2001;385-389.
• National Hemodialysis, Transplantation and Nephrology Registry Report of Turkey, 2008.
• Creswell, JW. Mixed-method research: Introduction and application. In: Handbook of educational policy. Academic press, 1999;455-472.
• Pelto, Pertti J. What is so new about mixed methods?. Qualitative Health Research. 2015;25(6): 734-745.
• Patton MQ. Qualitative Research.2005,New York: John Wiley & Sons, Ltd.
• Marshall C, Rossman GB.Designing Qualitative Research. 2014,New York: Sage.
• Miller LA, Stapleton FB. Urinary volume in children with urolithiasis. J Urol. 1989;141:918-920.
• Ece A, Ozdemir E, Gurkan F, Dokucu AI, Akdeniz O. Characteristics of pediatric urolithiasis in south-east Anatolia. Int J Urol. 2000;7:330-334.
• Chen Y, Deng T, Duan X, Zhu W, Zeng G. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric patients with upper urinary stones: a systematic review and meta-analysis. Urolithiasis. 2019;47(2):189-199.
• Matlaga BR, Schaeffer AJ, Novak TE, Trock BJ. Epidemiologic insights into pediatric kidney stone disease. Urol Res. 2010;38(6):453-457.
• Sas DJ. An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease. Clin J Am Soc Nephrol. 2011;6(8):2062-2068.
• Schaeffer AJ, Feng Z, Trock BJ, et al. Medical comorbidities associated with pediatric kidney stone disease. Urology. 2011;77(1):195-199.
• Klib M, Ghandour M, Wannous H. Urinary stone disease in Syrian children. Pediatr Nephrol. 2023;38(8):2699-2709.
• Kirkali Z, Rasooly R, Star RA, Rodgers GP. Urinary stone disease: progress, status, and needs. Urology. 2015;86(4):651-653.
• Spivacow FR, Del Valle EE, Boailchuk JA, et al. Metabolic risk factors in children with kidney stone disease: an update. Pediatr Nephrol. 2020;35(11):2107-2112.
• Sarica K. Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment. Urol Res. 2006;34(2):96-101.
• Rizvi SAH, Naqvi SAA, Hussain Z, et al. Pediatric urolithiasis: developing nation perspectives. J Urol. 2002;168(4 Pt 1):1522-1525.
• Ayyad M, Ayaad O. Measuring quality of life among patients with urinary stone disease: a qualitative study. J Ren Inj Prev. 2022;12(4).
• Culhane-Pera KA, Lee M. “Die another day”: a qualitative analysis of Hmong experiences with kidney stones. Hmong Stud J. 2006;7:1-16.
• Issler N, Dufek S, Kleta R, et al. Epidemiology of paediatric renal stone disease: a 22-year single centre experience in the UK. BMC Nephrol. 2017;18(1):1-8.
• Coward RJM, Peters CJ, Duffy PG, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child. 2003;88(11):962-965.