Clinical and metabolic features of urolithiasis and microlithiasis in children

Abstract

We evaluated the clinical, radiological and metabolic features of 162 children with urolithiasis or microlithiasis who had been referred to our pediatric nephrology clinics between 1998 and 2008 with suspected urolithiasis. The medical histories of these children (78 girls, 84 boys), who ranged in age from 2 months to 16 years (mean age 5.59 +/- 0.35 years), were reviewed retrospectively for clinical and metabolic features of urinary tract calculi. Urinary tract infections (UTI) were present in 45.9% of the cases. The most common presenting symptoms were flank pain or restlessness (25.3%) and hematuria (21.6%), followed by UTI (16%), whereas 23.5% of the cases were detected incidentally during evaluation for other medical conditions. Other symptoms at presentation included dysuria, passing stones, penile edema, enuresis, vomiting and anorexia. Urine analysis revealed metabolic abnormalities in 87% of the cases, including hypercalciuria (33.8%), hypocitraturia (33.1%), hyperoxaluria (26.5%), hyperuricosuria (25.4%), hypocitraturia + hypercalciuria (21.1%), hyperphosphaturia (20.8%) and cystinuria (5.7%). Almost 50% of the patients had a positive family history for urolithiasis. The most frequently involved site was in the kidneys (86%). Ureters and bladder were involved in 12 and 2% of the cases, respectively. A family history of urolithiasis, presenting symptoms and underlying metabolic abnormalities were similar for microlithiasis and the patients with larger stones. However, in our study population, microlithiasis was mainly a disease of young infants, with a greater chance for remission and often not associated with structural changes. The presenting symptoms of urolithiasis show a wide spectrum, so that a high index of suspicion is important for early detection. A metabolic abnormality can be identified in 87% of cases of urolithiasis. Detection of microlithiasis may explain a number of symptoms, thus reducing invasive diagnostic procedures and allowing early recognition of metabolic abnormalities. These results draw attention to the importance of screening for UTIs in patients with urolithiasis.

Risk Factors for Urolithiasis in Gastrostomy Tube Fed Children: A Case-Control Study

“…Previous studies of pediatric patients with urolithiasis in endemic regions have demonstrated a high rate of UTIs in patients with stones, ranging from 45.9% to 70%. [16][17][18] However, these investigations have noted varying rates of struvite stones (10%-44.8%). 16,19 Although we only have stone analysis results available on 8 patients, it is unlikely that the remainder of our patients had a significant struvite component, given the lack of staghorn calculi.…”

Urolithiasis in Childhood: Review

“…78 RKM'ye daha çok karın ağrısı, İYE ve hematüri, dizüri gibi semptomu olan çocuklarda rastlanmaktadır; ancak hiçbir semptomun olmadığı çocuklar da olabilmektedir. 77,79 Hastalar, daha büyük renal taşı olan çocuk hastalara göre genellikle daha küçüktür (infantil dönem). 77,79 RKM'ler renal taş oluşumunun ilk basamağı olarak kabul edilmektedir ve ilerleyen yaşlarda sıklıkla renal taş oluşumu ile birliktedir.…”

“…77,79 Hastalar, daha büyük renal taşı olan çocuk hastalara göre genellikle daha küçüktür (infantil dönem). 77,79 RKM'ler renal taş oluşumunun ilk basamağı olarak kabul edilmektedir ve ilerleyen yaşlarda sıklıkla renal taş oluşumu ile birliktedir. 78,80 Ancak Türkiye'den bildirilen iki çalış-mada, RKM'nin %37 hastada, diğer çalışmada ise %29 hastada zaman içerisinde kendiliğinden kaybolduğu saptanmıştır.…”

“…78,80 Ancak Türkiye'den bildirilen iki çalış-mada, RKM'nin %37 hastada, diğer çalışmada ise %29 hastada zaman içerisinde kendiliğinden kaybolduğu saptanmıştır. 77,79 RKM oluşumunda daha çok metabolik anomaliler, daha az olarak da anatomik anomaliler nedendir. Metabolik anomali olarak Türkiye'de en çok hiperkalsiüri saptanmıştır.…”

Investigação de nefrolitíase no Oeste do Paraná

“…It affects from 5 to 15% of the world population, and has a great impact on economy and health worldwide 1-3. In spite of the advances in surgical approaches, there have not been many changes in the history of nephrolithiasis. It affects youngsters between the third and fourth decades of life 4,5 , but it is also common in children 6 .…”