Metabolic features and renal outcomes of urolithiasis in children

Abstract

Aim: The incidence of pediatric urolithiasis has increased over the last century because of dietary changes, metabolic abnormalities, climate change, and genitourinary abnormalities. Data on pediatric urolithiasis in non-endemic countries are limited. The aim of this study was to evaluate the clinical findings and metabolic etiology of urolithiasis in Korean children. Material and methods: The medical records of 73 Korean children who were newly diagnosed with urolithiasis from January 2010 to December 2013 were retrospectively analyzed. Evaluation of metabolic risk factors, including hypercalciuria, hyperuricosuria, hypomagnesuria, hyperoxaluria, and hypocitraturia, required analysis of 24-h urine specimens or, alternatively, for infants and toddlers, the solute-creatinine ratio in spot urine. Results: The male-to-female ratio of the included patients was 1.3:1. The median age at diagnosis was 10.1 years, and the patients were divided into two age groups with pre-school-age children (n ¼ 27, 37.0%) and school-age children (n ¼ 46, 63.0%). While flank pain was more common in school-age children, incidentally detected or urinary tract infection (UTI)-associated urolithiasis was more common in pre-school-age children. Eight patients (11.0%) had renal function deterioration associated with urolithiasis, and three patients (4.1%) progressed to chronic kidney disease. Metabolic abnormalities according to urine chemistry were found in 30 patients (41.1%), including hypercalciuria in 21.9%, hyperuricosuria in 11.0%, hypomagnesuria in 4.1%, hyperoxaluria in 1.4%, hypocitraturia in 1.4%, and cystinuria in 1.4%. Conclusion: We suggest that school-age children with renal colic and pre-school-age children with UTI should be evaluated for urolithiasis. Additionally, the evaluation for metabolic risk factors is important in order to prevent recurrence and renal insufficiency. ARTICLE HISTORY

Genotype and Phenotype Analysis in Pediatric Patients with Cystinuria

“…There have been several clinical case reports and studies of Korean patients with cystinuria (691011121314). However, only 2 case reports published include genetic studies: one was that of a 13-year-old boy with a single heterozygous SLC7A9 mutation (c.517G>A, p.G173R) (11), and the other was of an 8-month-old girl with a homozygous SLC3A1 mutation (c.1820delT, p.L607fs) (10).…”

Risk factors for development of urinary tract infection in children with nephrolithiasis

“…The majority of the children with nephrolithiasis have a metabolic risk factor for the development of kidney stones. Lee and Cho showed that there was a metabolic risk factor in 30 (41%) of 70 patients . Coward et al found that the most common metabolic risk factor was hypercalciuria, followed by cystinuria .…”

Biochemical metabolic levels and vitamin D receptor FokⅠ gene polymorphisms in Uyghur children with urolithiasis

“…The factors contributing to the occurrence of urolithiasis among Uyghur children are complicated and mainly include socioeconomic status, racial difference, environmental condition, lifestyle change, diet habit, biochemical metabolic disturbance and genetic diversity [2,7–9]. Biochemical metabolic abnormalities play a crucial role in stone formation in children [10,11]. A high proportion of upper urinary tract stones was found correlated with biochemical metabolic disturbance, which may be derived from the dietary and environmental factors[12,13].…”