Metabolic Abnormalities in Children Younger Than Two Years with Urolithiasis: A Single-Center Case–Control Study

Öz

Purpose: Pediatric urolithiasis has become more prevalent in recent years; however, studies focusing on urolithiasis in infancy are limited and mostly retrospective. The aim of this study was to compare the clinical, nutritional, and metabolic characteristics of children younger than two years with urolithiasis and age- and sex-matched healthy controls. Material and Methods: This single-center, case-control study included 30 children under 2 years of age diagnosed with urolithiasis and 30 age- and sex-matched healthy controls. Demographic characteristics, family history, nutritional and medication history, and presenting symptoms were recorded. All subjects underwent urinary ultrasonography and laboratory evaluation. Results: There were no significant differences between the patients and controls in terms of age (11.1±5.35 vs. 11.3±5.33 months) or male-to-female ratio (1.7:1 vs. 1.3:1). A positive family history of urolithiasis was significantly more common in patients than in controls (47% vs. 10%, p=0.003), whereas feeding practices, early water intake, and prematurity did not differ between groups. Restlessness was the most common presenting symptom (40.0%), and 16.7% of patients were asymptomatic. A total of 59 stones were identified; 16 patients (53.3%) had multiple stones and eight (26.7%) had bilateral stones, and 22 stones (37.3%) measured <3 mm. At least one metabolic abnormality was detected in 21 patients (70.0%), and five (16.7%) had more than one abnormality. Hypercalciuria (36.7% vs. 10.0%, p=0.015) and hypocitraturia (30.0% vs. 6.7%, p=0.020) were more frequent among patients. Conclusion: Urolithiasis in children younger than two years is frequently accompanied by a positive family history and metabolic abnormalities. Hypercalciuria and hypocitraturia were more commonly detected in affected children than in healthy controls.

Anahtar Kelimeler

• children
• urinary system stones
• urolithiasis
• infections

Destekleyen Kurum

Turkish Pediatric Association.

İki Yaşından Küçük Ürolitiyazisli Çocuklarda Metabolik Anormallikler: Tek Merkezli Bir Olgu-Kontrol Çalışması

Öz

Amaç: Pediatrik ürolitiyazis son yıllarda daha yaygın hale gelmiştir; ancak bebeklik dönemindeki ürolitiyazise odaklanan çalışmalar sınırlı sayıdadır ve çoğunlukla retrospektiftir. Bu çalışmanın amacı, iki yaşından küçük ürolitiyazisli çocukların klinik, beslenme ve metabolik özelliklerini yaş ve cinsiyet açısından eşleştirilmiş sağlıklı kontrollerle karşılaştırmaktır. Gereç ve Yöntem: Bu tek merkezli olgu-kontrol çalışmasına, ürolitiyazis tanısı alan iki yaşından küçük 30 çocuk ile yaş ve cinsiyet açısından eşleştirilmiş 30 sağlıklı kontrol dahil edildi. Demografik özellikler, aile öyküsü, beslenme ve ilaç kullanımı öyküsü ile başvuru semptomları kaydedildi. Tüm olgulara üriner ultrasonografi ve laboratuvar değerlendirmesi yapıldı. Bulgular: Hastalar ve kontroller arasında yaş (11,1±5,35 aya karşı 11,3±5,33 ay) veya erkek/kız oranı (1,7:1'e karşı 1,3:1) açısından anlamlı fark yoktu. Pozitif ürolitiyazis aile öyküsü, hastalarda kontrollere göre anlamlı derecede daha sık saptandı (%47'ye karşı %10, p=0,003); buna karşın beslenme şekli, erken su alımı ve prematürite açısından gruplar arasında fark bulunmadı. En sık başvuru semptomu huzursuzluktu (%40,0) ve hastaların %16,7'si asemptomatikti. Toplam 59 taş saptandı; 16 hastada (%53,3) birden fazla taş, 8 hastada (%26,7) bilateral taş vardı ve taşların 22'si (%37,3) 3 mm'den küçüktü. Hastaların 21'inde (%70,0) en az bir metabolik anormallik saptanırken, 5 hastada (%16,7) birden fazla metabolik anormallik mevcuttu. Hiperkalsiüri (%36,7'ye karşı %10,0; p=0,015) ve hipositratüri (%30,0'a karşı %6,7; p=0,020) hastalarda kontrollere göre daha sık görüldü. Sonuç: İki yaşından küçük çocuklarda ürolitiyazise sıklıkla pozitif aile öyküsü ve metabolik anormallikler eşlik etmektedir. Hiperkalsiüri ve hipositratüri, etkilenen çocuklarda sağlıklı kontrollere göre daha sık saptanmıştır.

Anahtar Kelimeler

• çocuklar
• üriner sistem taşları
• ürolitiyazis
• enfeksiyonlar

Destekleyen Kurum

Türk Pediatri Kurumu

Kaynakça

1. Ali, S. H., & Rifat, U. N. (2005). Etiological and clinical patterns of childhood urolithiasis in Iraq. Pediatric Nephrology, 20(10), 1453-1457.
2. Alon, U. S., Zimmerman, H., & Alon, M. (2004). Evaluation and treatment of pediatric idiopathic urolithiasis— revisited. Pediatric Nephrology, 19(5), 516-520.
3. Alpay, H., Ozen, A., Gokce, I., & Biyikli, N. (2009). Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatric Nephrology, 24(11), 2203-2209.
4. Bakkaloglu, S. A., Ekim, M., Sever, L., Noyan, A., Aksu, N., Akman, S.,… Kara, O. D. (2005). Chronic peritoneal dialysis in Turkish children: A multicenter study. Pediatric Nephrology, 20(5), 644-651.
5. Barratt, T. M., & Duffy, P. G. (1999). Nephrocalcinosis and urolithiasis. In T. M. Barratt, E. D. Avner, & W. E. Harmon (Eds.), Pediatric nephrology (4th ed., pp. 933- 946). Lippincott Williams & Wilkins.
6. Basaklar, A., & Kale, N. (1991). Experience with childhood urolithiasis: Report of 196 cases. British Journal of Urology, 67(2), 203-205.
7. Baştuğ, F., Ağbaş, A., Tülpar, S., Yıldırım, Z. N. Y., Cicek, N., Günay, N.,… Nalçacıoğlu, H. (2022). Comparison of infants and children with urolithiasis: A large case series. Urolithiasis, 50(4), 411-421.
8. Cameron, M. A., Sakhaee, K., & Moe, O. W. (2005). Nephrolithiasis in children. Pediatric Nephrology, 20(11), 1587-1592. doi:10.1007/s00467-005-1883-z

9. Campfield, T., Braden, G., Flynn-Valone, P., & Clark, N. (1994). Urinary oxalate excretion in premature infants: Effect of human milk versus formula feeding. Pediatrics, 94(5), 674-678.
10. Coward, R., Peters, C., Duffy, P., Corry, D., Kellett, M., Choong, S., & Van't Hoff, W. (2003). Epidemiology of paediatric renal stone disease in the UK. Archives of Disease in Childhood, 88(11), 962-965.
11. Çaltik Yilmaz, A., Ünal, N., Çelebi Tayfur, A., & Büyükkaragöz, B. (2022). How important urolithiasis is under 2 years of age? Urolithiasis, 50(2), 159-165.
12. 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.
13. Ece, A., Özdemir, E., Gürkan, F., Dokucu, A. I., & Akdeniz, O. (2000). Characteristics of pediatric urolithiasis in south-east Anatolia. International Journal of Urology, 7(9), 330-334.
14. Eckstein, H. B. (1961). Endemic urinary lithiasis in Turkish children: A clinical study of 119 cases. Archives of Disease in Childhood, 36(186), 137.
15. Edvardsson, V., Elidottir, H., Indridason, O. S., & Palsson, R. (2005). High incidence of kidney stones in Icelandic children. Pediatric Nephrology, 20(7), 940-944. doi:10.1007/s00467-005-1861-5
16. Elder, J. S. (n.d.). Urinary lithiasis. In R. E. Behrman, R. M. Kliegman, & H. B. Jenson (Eds.), Nelson textbook of pediatrics (17th ed., pp. 1822-1826). Saunders.
17. Erbagci, A., Erbagci, A. B., Yilmaz, M., Yagci, F., Tarakcioglu, M., Yurtseven, C.,… Sarica, K. (2003). Pediatric urolithiasis. Scandinavian Journal of Urology and Nephrology, 37(2), 129-133.
18. Ertan, P., Tekin, G., Öger, N., Alkan, S., & Horasan, G. D. (2011). Metabolic and demographic characteristics of children with urolithiasis in Western Turkey. Urological Research, 39(2), 105-110.
19. Gearhart, J. P., Herzberg, G. Z., & Jeffs, R. D. (1991). Childhood urolithiasis: Experiences and advances. Pediatrics, 87(4), 445-450.
20. Gefen, A. M., Sethna, C. B., Cil, O., Perwad, F., Schoettler, M., Michael, M.,… Hunley, T. E. (2023). Genetic testing in children with nephrolithiasis and nephrocalcinosis. Pediatric Nephrology, 38(8), 2615-2622.
21. Gefen, A. M., & Zaritsky, J. J. (2024). Review of childhood genetic nephrolithiasis and nephrocalcinosis. Frontiers in Genetics, 15, 1381174.
22. Gür Güven, A., Koyun, M., Emre Baysal, Y., Akman, S., Alimoglu, E., Akbas, H., & Kabaalioglu, A. (2010). Urolithiasis in the first year of life. Pediatric Nephrology, 25(1), 129-134.
23. Hoppe, B., Roth, B., Bauerfed, C., & Langman, C. B. (1998). Oxalate, citrate, and sulfate concentration in human milk compared with formula preparations: Influence on urinary anion excretion. Journal of Pediatric Gastroenterology and Nutrition, 27(4), 383-386.
24. Jallouli, M., Mhiri, R., & Nouri, A. (2007). Urolithiasis in infants. Pediatric Surgery International, 23(4), 295- 299. Kamoun, A., Daudon, M., Abdelmoula, J., Hamzaoui, M., Chaouachi, B., Houissa, T.,… Lakhoua, R. (1999). Urolithiasis in Tunisian children: A study of 120 cases based on stone composition. Pediatric Nephrology, 13(9), 920-925.
25. Milliner, D. S. (2009). Urolithiasis. In E. D. Avner, W. E. Harmon, P. Niaudet, & N. Yoshikawa (Eds.), Pediatric nephrology (6th ed., pp. 1405-1430). Lippincott
26. Williams & Wilkins.Milliner, D. S., & Murphy, M. E. (1993). Urolithiasis in pediatric patients. Mayo Clinic Proceedings, 68(3), 241-248. doi:10.1016/s0025-6196(12)60043-3
27. Özokutan, B., Küçükaydin, M., Gündüz, Z., Kabaklioğlu, M., Okur, H., & Turan, C. (2000). Urolithiasis in childhood. Pediatric Surgery International, 16(1), 60-63.
28. Pięta, J., Szyszka, M., Lipiński, P., & Skrzypczyk, P. (2026). Urolithiasis in children—Clinical picture, pathogenesis, and diagnostic approach. Biomolecules, 16(1), 119.
29. Remzi, D. (1981). A study on urolithiasis incidence in school-age children. J Med, 13, 211-215.
30. Sarkissian, A., Babloyan, A., Arikyants, N., Hesse, A., Blau, N., & Leumann, E. (2001). Pediatric urolithiasis in Armenia: A study of 198 patients observed from 1991 to 1999. Pediatric Nephrology, 16(9), 728-732.
31. Schell-Feith, E. A., Kist-van Holthe, J. E., & van der Heijden, A. J. (2010). Nephrocalcinosis in preterm neonates. Pediatric Nephrology, 25(2), 221-230.
32. Sikora, P., Roth, B., Kribs, A., Michalk, D. V., Hesse, A., & Hoppe, B. (2003). Hypocitraturia is one of the major risk factors for nephrocalcinosis in very low birth weight (VLBW) infants. Kidney International, 63(6), 2194-2199.
33. Spasiano, A., Treccani, M., De Tomi, E., Malerba, G., Gambaro, G., & Ferraro, P. M. (2024). Characteristics and yield of modern approaches for the diagnosis of genetic causes of kidney stone disease. Genes, 15(11), 1470.
34. Spivacow, F. R., Negri, A. L., del Valle, E. E., Calviño, I., Fradinger, E., & Zanchetta, J. R. (2008). Metabolic risk factors in children with kidney stone disease. Pediatric Nephrology, 23(7), 1129-1133.
35. Stapleton, F. B. (2002). Childhood stones. Endocrinology and Metabolism Clinics of North America, 31(4), 1001- 1015. doi:10.1016/s0889-8529(02)00036-1
36. Tefekli, A., Esen, T., Ziylan, O., Erol, B., Armagan, A., Ander, H., & Akinci, M. (2003). Metabolic risk factors in pediatric and adult calcium oxalate urinary stone formers: Is there any difference? Urologia Internationalis, 70(4), 273-277.doi:10.1159/000070134
37. Van’t Hoff, W. G. (2004). Aetiological factors in paediatric urolithiasis. Nephron Clinical Practice, 98(2), c45-c48. doi:10.1159/000080251
38. Walther, P. C., Lamm, D., & Kaplan, G. W. (1980). Pediatric urolithiasis: A ten-year review. Pediatrics, 65(6), 1068-1072.