Pediatric urolithiasis: metabolic risk factors and follow-up results in a Turkish region with endemic stone disease

Abstract

The goal of this study was to investigate the metabolic etiology, clinical findings and medical treatment of children with urolithiasis in an endemic region of Turkey. We retrospectively analyzed the medical records of 742 (437 males, 305 females) children with urolithiasis. Physical examination results, serum biochemistry and urine metabolic evaluation, including urinary citrate, oxalate, calcium, uric acid, cystine and magnesium levels were recorded. We obtained follow-up records in 316 patients to evaluate the association between stone recurrence and metabolic risk factors. The mean age at diagnosis was 2.6 ± 3.4 (0.1-17.0) years. Male-to-female ratio was 1.4:1. A family history of stone disease was found in 76.5 % of patients and 41 % of parents had consanguineous marriage. The most common presenting symptoms were urinary tract infection (UTI, 23.9 %) and hematuria (23.6 %). Metabolic abnormalities were found in 588 (79.2 %) patients, including hypercalciuria in 31.5 %, hypocitraturia in 24.2 %, hyperoxaluria in 11.4 %, hyperuricosuria in 9.1 %, hypomagnesuria in 3.9 %, and cystinuria in 3.1 % of patients. The frequency of hyperoxaluria and hypocitraturia were significantly higher in patients with new stone formation. Follow-up records of 316 (42.6 %) patients (192 males, 124 females) were available. Urolithiasis was shown in 135 (42.7 %) of the patients on control ultrasonography, and 61.5 % of these patients had a stone size ≤ 3 mm. Hyperoxaluria and cystinuria were significantly higher in patients with stone persistence. The main goal of management for children with urolithiasis should be identification of risk factors.

A Comparison between Clinical and Metabolic Features of Renal Calyceal Microlithiasis and Overt Urolithiasis in Different Pediatric Age Groups

“…This percentage was almost similar to other studies conducted in the United States, Mexico, Italy and Turkey [7,14,15,16]. These findings show that regardless of the region and race, most children with urolithiasis have underlying metabolic abnormalities.…”

“…Hypocitraturia was the main metabolic abnormality in older children and adolescents with urolithiasis, which is in accordance with other global studies [9,14,15,22,23,24]. Kovacevic et al [23] indicated that there is a shift from hypercalciuria to hypocitraturia as the predominant metabolic abnormality in pediatric urolithiasis.…”

“…Hyperoxaluria is increasing among children with urolithiasis; based on a recent review, increased urinary oxalate excretion is underestimated and might even be a more prevalent risk factor than hypercalciuria for stone diseases [2]. The changes in dietary habits and consumption of oxalate-rich foods among the pre-school children seem to be an important cause of hyperoxaluria in these children; studies have shown that hyperoxaluria is significantly higher when the children are >1 year and are switched to solid foods [12,14]. The hot climate and higher prevalence of consanguineous marriage are other causes of hyperoxaluria in our region [17,19].…”

Pediatric Nephrolithiasis: Trend, Evaluation and Management: A Systematic Review

“…Medication may be a part of management of children with recurrent nephrolithiasis, solitary kidney, or metabolic disorders. In this context, the result of stone analysis or a 24-hour urine collection analysis plays an important role (33,39,69,70). Thiazides and potassium-sparing diuretics are on top of the list.…”

Metaphylaxis in Pediatric Urinary Stone Disease

“…Children with metabolic disorders had a higher recurrence rate, so metabolic examination is essential to preventive treatment in children. In the pediatric age group, the most common metabolic disorders are hypercalciuria and hypocitraturia, with hypercalciuria more often found in the endemic areas and hypocitraturia in the nonendemıc areas [3,4]. Metaphylaxis has been found to reduce recurrence rates by about half, even in recurrent kidney stones [5].…”