Etiological Evaluation in Pediatric Urinary Stone Disease

Year 2023, , 178 - 185, 30.04.2023

Mihriban İnözü , Banu Acar , Fatma Özcan Sıkı , Fatma Şemsa Çaycı , Tuğrul Tiryaki , Nilgün Çakar

https://doi.org/10.36516/jocass.1254002

Abstract

Introduction: Urinary stone disease is an important health problem commonly seen in some regions of the world. Determining the etiology is important for effective treatment and prevention of recurrence. The aim of this study was to evaluate the demographic and clinical features, metabolic and other risk factors of children with urinary stone disease.
Methods: A total of 766 patients with urinary stone disease presented to our pediatric nephrology department over 15 years. The patients’ demographic, clinical, and treatment data were retrospectively analyzed.
Results: The mean age at diagnosis was 61.6±52.7 months. The male/female ratio was 1.15:1. There was no significant difference in age at diagnosis between the sexes. The most frequent presenting complaint overall was abdominal pain. Chronic renal failure was present in 1.8% and family history in 57.5% of the patients. Metabolic abnormalities were detected in 51% of the patients, urinary tract infection in 44.8%, and urinary tract anomalies in 13.2%. No cause could be identified in the other 22.7% of the patients. Urinary tract infection was the most common etiology in patients younger than 1 year old, while metabolic risk factors were more frequent in patients aged 1-10 years. Metabolic abnormalities included hypercalciuria (51.7%), hypocitraturia (47.5%), hyperoxaluria (39.9%), hyperuricosuria (23.4%), and cystinuria (9.4%). Bilateral and multiple stones were associated with metabolic abnormalities (p<0.001 and p=0.011). Nearly all stones (96.5%) were located in upper urinary tract and 1.8% were in the bladder. Calcium oxalate was the most common type of stone (61.7%). In terms of treatment, 32.5% of patients received medical treatment, 7.9% underwent extracorporeal shock-wave lithotripsy, and 14.3% had surgery. During follow-up, 30.1% of patients exhibited complete resolution and the other 69.9% had persistent disease.
Conclusion: Urinary stone disease is an important health problem in childhood and requires a thorough evaluation of metabolic risk factors to clarify the etiology. Treating metabolic and structural abnormalities and controlling urinary tract infection are important to protect renal function and prevent recurrence.

Keywords

Urinary stone, child, metabolic abnormalities

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