Etiological Evaluation in Pediatric Urinary Stone Disease

Yıl 2023, , 178 - 185, 30.04.2023

Mihriban İnözü , Banu Acar , Fatma Özcan Sıkı , Fatma Şemsa Çaycı , Tuğrul Tiryaki , Nilgün Çakar

https://doi.org/10.36516/jocass.1254002

Öz

Introduction: Urinary stone disease is an important health problem commonly seen in some regions of the world. Determining the etiology is important for effective treatment and prevention of recurrence. The aim of this study was to evaluate the demographic and clinical features, metabolic and other risk factors of children with urinary stone disease.
Methods: A total of 766 patients with urinary stone disease presented to our pediatric nephrology department over 15 years. The patients’ demographic, clinical, and treatment data were retrospectively analyzed.
Results: The mean age at diagnosis was 61.6±52.7 months. The male/female ratio was 1.15:1. There was no significant difference in age at diagnosis between the sexes. The most frequent presenting complaint overall was abdominal pain. Chronic renal failure was present in 1.8% and family history in 57.5% of the patients. Metabolic abnormalities were detected in 51% of the patients, urinary tract infection in 44.8%, and urinary tract anomalies in 13.2%. No cause could be identified in the other 22.7% of the patients. Urinary tract infection was the most common etiology in patients younger than 1 year old, while metabolic risk factors were more frequent in patients aged 1-10 years. Metabolic abnormalities included hypercalciuria (51.7%), hypocitraturia (47.5%), hyperoxaluria (39.9%), hyperuricosuria (23.4%), and cystinuria (9.4%). Bilateral and multiple stones were associated with metabolic abnormalities (p<0.001 and p=0.011). Nearly all stones (96.5%) were located in upper urinary tract and 1.8% were in the bladder. Calcium oxalate was the most common type of stone (61.7%). In terms of treatment, 32.5% of patients received medical treatment, 7.9% underwent extracorporeal shock-wave lithotripsy, and 14.3% had surgery. During follow-up, 30.1% of patients exhibited complete resolution and the other 69.9% had persistent disease.
Conclusion: Urinary stone disease is an important health problem in childhood and requires a thorough evaluation of metabolic risk factors to clarify the etiology. Treating metabolic and structural abnormalities and controlling urinary tract infection are important to protect renal function and prevent recurrence.

Anahtar Kelimeler

Urinary stone, child, metabolic abnormalities

Kaynakça

• Marra G, Taroni F, Berrettini A, et al. Pediatric nephrolithiasis: a systematic approach from diagnosis to treatment. J Nephrol. 2019;32(2):19
• Reusz GS, Hosszu A, Kis E. Evaluation of a child with suspected nephrolithiasis. Curr Opin Pediatr. 2020;32(2):265-272.
• Rodriguez Cuellar CI, Wang PZT, Freundlich M, et al. Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol. 2020;35(3):383-397.
• Bek K, Akman S, Bilge I, et al. Chronic kidney disease in children in Turkey. Pediatr Nephrol. 2009;24(4):797-806.
• Hernandez JD, Ellison JS, Lendvay TS. Current Trends, Evaluation, and Management of Pediatric Nephrolithiasis. JAMA Pediatr. 2015;169(10):964-970.
• Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol. 2010;25(3):403-413.
• Dursun I, Poyrazoglu HM, Dusunsel R, et al. Pediatric urolithiasis: an 8-year experience of single centre. Int Urol Nephrol. 2008;40(1):3-9.
• Elmaci AM, Ece A, Akin F. Pediatric urolithiasis: metabolic risk factors and follow-up results in a Turkish region with endemic stone disease. Urolithiasis. 2014;42(5):421-426.
• Gajengi AK, Wagaskar VG, Tanwar HV, et al. Metabolic Evaluation in Paediatric Urolithiasis: A 4-Year Open Prospective Study. J Clin Diagn Res. 2016;10(2):PC04-06
• Acar B, Inci Arikan F, Emeksiz S, et al. Risk factors for nephrolithiasis in children. World J Urol. 2008;26(6):627-630.
• Girisgen I, Yuksel S, Karcili K, et al. Evaluation of the composition of urinary tract stones in children from the Inner Western Anatolian Region in Turkey. Turk J Urol. 2020;46(2):152-158.
• Spivacow FR, Negri AL, del Valle EE, et al. Metabolic risk factors in children with kidney stone disease. Pediatr Nephrol. 2008;23(7):1129-1133.
• 1Lee ST, Cho H. Metabolic features and renal outcomes of urolithiasis in children. Ren Fail. 2016;38(6):927-932.
• Elmaci AM, Ece A, Akin F. Clinical characteristics and metabolic abnormalities in preschool-age children with urolithiasis in southeast Anatolia. J Pediatr Urol. 2014;10(3):495-499.
• Sternberg K, Greenfield SP, Williot P, et al. Pediatric stone disease: an evolving experience. J Urol. 2005;174(4 Pt 2):1711-1714; discussion 1714.
• Erbagci A, Erbagci AB, Yilmaz M, et al. Pediatric urolithiasis--evaluation of risk factors in 95 children. Scand J Urol Nephrol. 2003;37(2):129-133.
• Bak M, Ural R, Agin H, et al. The metabolic etiology of urolithiasis in Turkish children. Int Urol Nephrol. 2009;41(3):453-460.
• Celiksoy MH, Yilmaz A, Aydogan G, et al. Metabolic disorders in Turkish children with urolithiasis. Urology. 2015;85(4):909-913.
• Bevill M, Kattula A, Cooper CS, et al. The Modern Metabolic Stone Evaluation in Children. Urology. 2017;101:15-20.
• Knoll T, Zollner A, Wendt-Nordahl G, et al. Cystinuria in childhood and adolescence: recommendations for diagnosis, treatment, and follow-up. Pediatr Nephrol. 2005;20(1):19-24.
• Ertan P, Tekin G, Oger N, et al. Metabolic and demographic characteristics of children with urolithiasis in Western Turkey. Urol Res. 2011;39(2):105-110.
• Azili MN, Ozturk F, Inozu M, et al. Management of stone disease in infants. Urolithiasis. 2015;43(6):513-519.
• Ali SH, Rifat UN. Etiological and clinical patterns of childhood urolithiasis in Iraq. Pediatr Nephrol. 2005;20(10):1453-1457.