Metabolic Risk Factors in Children with Urinary System Stones

Year 2024, Volume: 19 Issue: 2, 78 - 84, 29.06.2024

Mahmut Civilibal , Ata Mert Çivilibal , Mesrur Selçuk Sılay

https://doi.org/10.33719/nju1493722

Abstract

Objective: For the diagnosis, specific treatment and prevention of stone recurrence, it is important to determine the metabolic risk factors that play a role in the development of urinary system stone disease in children. The clinical, radiological and metabolic characteristics of children with urinary system stones were assessed in this study.
Methods: A retrospective study was conducted in the records of paediatric patients who applied to our pediatric outpatient nephrology clinic for various reasons between February 2018 and December 2023, diagnosed with urinary system stones.
Results: Of the 122 patients with a mean age of 4.40±4.16 years (1 month-17 years), 63 (51.6%) were boys and 59 (48.4%) were girls. In 61.4% of the children, a family history was identified. The most common presenting symptom was abdominal/flank pain or restlessness (47.5%). In 25.4% of the patients, the stones were ≤3 mm (microlithiasis) and most of the stones were located in the upper system. One or more metabolic abnormalities have been detected during urine analysis for 58.2% of patients. The most frequent metabolic abnormalities were hypercalciuria (20.5%) and hypocitraturia (17 2%). In 74.6% of patients, the size of stones decreased or completely disappeared with medical treatment based on underlying metabolic abnormalities and in 17.2% they did not change at all. Only eight (6.6%) patients required interventional procedures.
Conclusion: In all children with urinary tract stones, metabolic causes should be investigated first. The need for invasive stone procedures is reduced by special medical treatments designed to alter metabolism.

Keywords

Childhood, Urinary System Stone, metabolic risk factors, hypercalciuria, hypocitraturia

Ethical Statement

Memorial Bahçelievler Hospital Ethics Committee, Approval Number: 114, Date: 2024-01-25.

Metabolic Risk Factors in Children with Urinary System Stones

Abstract

Objective: To diagnose, treat, and prevent stone recurrence, it is important to determine the metabolic risk factors that play a role in developing urinary system stone disease in children. This study assessed children with urinary system stones’ clinical, radiological, and metabolic characteristics.
Material And Methods: A retrospective study was conducted on the records of pediatric patients who applied to our pediatric outpatient nephrology clinic for various reasons between February 2018 and December 2023 and were diagnosed with urinary system stones.
Results: Of the 122 patients with a mean age of 4.40±4.16 years (1 month-17 years), 63 (51.6%) were boys and 59 (48.4%) were girls. In 61.4% of the children, a family history was identified. The most common presenting symptom was abdominal/flank pain or restlessness (47.5%). In 25.4% of the patients, the stones were ≤3 mm (microlithiasis), and most stones were in the upper system. One or more metabolic abnormalities have been detected during urine analysis for 58.2% of patients. The most frequent metabolic abnormalities were hypercalciuria (20.5%) and hypocitraturia (17.2%). In 74.6% of patients, the size of stones decreased or completely disappeared with medical treatment based on underlying metabolic abnormalities, and in 17.2%, they did not change at all. Only eight (6.6%) patients required interventional procedures.
Conclusion: Metabolic causes should be investigated first in all children with urinary tract stones. Special medical treatments designed to alter metabolism reduce the need for invasive stone procedures.

Keywords

Childhood, Urinary System Stone, metabolic risk factors, hypercalciuria, hypocitraturia

Ethical Statement

The study was approved by Ethics Committee of Memorial Bahçelievler Hospital (decision no: 114, date: 25.01.2024). The study protocol conformed to the ethical guidelines of the Helsinki Declaration.

Supporting Institution

None

Thanks

None

References

• 1. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC, Rule AD. Temporal trends in incidence of kidney stones among children: a 25-year population based study. J Urol 2012;188:247-252. https://doi.org/10.1016/j.juro.2012.03.021
• 2. Pearle MS, Antonelli JA, Lotan Y. Urinary Lithiasis: Etiology, Epidemology, and Pathogenesis. In: Wein AJ (ed) CampbellWalsh Urology, 17th edn. Philadelphia: Elsevier; 2016. p.1170-1199. https://doi.org/10.1016/j.eururo.2014.06.036
• 3. Çivilibal M, Selçuk Duru N, Elevli M. Çocuklarda Üriner Sistem Taşları. Med Bull Haseki 2016;54:1-6. https://doi.org/10.4274/haseki.2727
• 4. Coward RJ, Peters CJ, Duffy PG, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 2003; 88:962-965. https://doi.org/10.1136/adc.88.11.962
• 5. Perrone HC, dos Santos DR, Santos MV, et al. Urolithiasis in childhood: metabolic evaluation. Pediatr Nephrol 1992; 6:54-56. https://doi.org/10.1007/BF00856834
• 6. Celiksoy MH, Yilmaz A, Aydogan G, Kiyak A, Topal E, Sander S. Metabolic disorders in Turkish children with urolithiasis. Urology 2015;85:909-913. https://doi. org/10.1016/j.urology.2014.12.032
• 7. Spivacow FR, Del Valle EE, Boailchuk JA, Díaz GS, Ugarte VR, Álvarez ZA. Metabolic risk factors in children with kidney stone disease: an update. Pediatr Nephrol 2020;35:2107-2112. https://doi.org/10.1007/ s00467-020-04660-x
• 8. Drach GW. Metabolic evaluation of pediatric patients with stones. Urol Clin North Am 1995;22:95-100. PMID: 7855963
• 9. Clayton DB, Pope JC. The increasing pediatric stone disease problem. Ther Adv Urol 2011;3:3-12. https://doi. org/10.1177/1756287211400491
• 10. Ece A, Ozdemir E, Gurkan F, Dokucu AI, Akdeniz O. Characteristics of pediatric urolithiasis in southeast Anatolia. Int J Urol 2000;7:330-334. https://doi. org/10.1046/j.1442-2042.2000.00207.x
• 11. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Family history and risk of kidney stones. J Am Soc Nephrol 1997;8:1568-1573. https://doi. org/10.1681/ASN. V8101568
• 12. Öner A, Demircin G, Ipekçioglu H, Bulbul M, Ecin N. Etiological and clinical patterns of urolithiasis in Turkish children. Eur Urol 1997;31:453-458. https://doi.org/10.1159/000474506
• 13. Melek E, Gülleroğlu KS, Bayrakçı US, Aygün C, Baskın E. Üriner sistem taşı olan çocuk hastaların klinik ve metabolik özellikleri. Türkiye Çocuk Hast Derg. 2016;1:40-45. https://doi. org/10.12956/tjpd.2015.168
• 14. Taşdemir M. Üriner sistem taşı olan çocuklarda metabolik bozukluklar ve cinsiyetin etkisi. Şişli Etfal Hastanesi Tıp Bülteni 2017;51:218-224. https://doi. org/10.5350/SEMB.2017041701410
• 15. VanDervoort K, Wiesen J, Frank R, et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 2007;177:2300- 2305. https://doi. org/10.1016/j.juro.2007.02.002
• 16. Kalorin CM, Zabinski A, Okpareke I, White M, Kogan BA. Pediatric urinary stone disease--does age matter? J Urol 2009;181:2267-2271. https://doi.org/10.1016/j. juro.2009.01.050
• 17. Cassim R, Van Walraven C, Lavallée LT, et al. Systematic radiologic detection of kidney stones in Canadian children: a new era of asymptomatic stones? J Pediatr Urol 2019;15:467.e1-467.e7. https://doi.org/10.1016/j.jpurol.2019.05.012
• 18. Alpay H, Ozen A, Gokce I, Biyikli N. Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatr Nephrol 2009;24:2203-229. https://doi. org/10.1007/s00467-009-1231-9
• 19. Kara A, Gürgöze MK, Gözütok AU. Üriner Sistem Taş Hastalığı Olan Çocukların Metabolik Değerlendirmesi. Fırat Tıp Dergisi 2018;23:142-145.
• 20. Penido MG, Srivastava T, Alon US. Pediatric primary urolithiasis: 12-year experience at a Midwestern Children’s Hospital. J Urol 2013;189:1493-1497. https://doi.org/10.1016/j.juro.2012.11.107
• 21. DeFoor W, Minevich E, Jackson E, et al. Urinary metabolic evaluations in solitary and recurrent stone forming children. J Urol 2008;179:2369-2372. https://doi.org/10.1016/j.juro.2008.01.151
• 22. Ertan P, Tekin G, Oger N, Alkan S, Horasan GD. Metabolic and demographic characteristics of children with urolithiasis in Western Turkey. Urol Res 2011;39:105-110. https://doi.org/10.1007/s00240-010- 0306-1
• 23. Aladjem M, Barr J, Lahat E, Bistritzer T. Renal and absorptive hypercalciuria: a metabolic disturbance with varying and interchanging modes of expression. Pediatrics 1996;97:216-219.
• 24. Hess B, Michel R, Takkinen R, Ackermann D, Jaeger P. Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list. Nephrol Dial Transplant 1994;9:642-649. https://doi.org/10.1093/ndt/9.6.642
• 25. Gürgöze MK, Sarı MY. Results of medical treatment and metabolic risk factors in children with urolithiasis. Pediatr Nephrol 2011;26:933-937. https://doi. org/10.1007/s00467-011-1803-3
• 26. Elmacı AM, Ece A, Akın F. Clinical characteristics and metabolic abnormalities in preschool-age children with urolithiasis in South-East Anatolia. J Pediatr Urol 2014;10:495-499. https://doi.org/10.1016/j. jpurol.2013.11.004