Clinical presentation and metabolic features of urinary stones in children: Single center experience

Year 2019, , 59 - 66, 25.04.2019

Atilla Gemici , Bahriye Atmış Raziye Ergün

https://doi.org/10.30565/medalanya.506673

Abstract

Aim: We aimed to evaluate the demographic characteristics, metabolic etiology, and response to treatment of children who admitted to our hospital with an urinary stone disease (USD) in our study. 

Patients and Method: The medical records of 259 patients who had been diagnosed with USD, between 01/04/2017-31/03/2018 were reviewed retrospectively. 

Results: The most common presenting symptoms of the patients were USD detected by ultrasonography performed for other reasons (n: 100, 38.6%). 52 of the patients (20.1%) had pyuria and urine culture positivity. Hematuria was detected in 31 (11.2%) patients. Hypocitraturia (38/82) 46.3%, hypomagnesuria (22/116) 13.2%, hypercalciuria (28/225) 12.4%, hyperuricosuria (17/219) 7.7%, hyperoxaluria (4/76) 5.2% was found in cases. Serum vitamin D levels were high in 5.8% of cases (15/259). The most common localization of stone was lower kidney pole (38.2%). Medical treatment was given to 92 (35.5%) patients while extracorporeal shock wave lithotripsy (ESWL) was performed in 34 (13.12%) patients and other surgical procedures were performed in 9 (3.74%) cases. Concurrent medical and surgical treatment was performed in 17 patients. The median follow-up period of 199 cases under followed-up was 3 months (1-12 months). In the last follow-up, 142 (71.35%) of the patients showed improvement, while 36 (18.05%) had no change in stone size, and 21 (10.6%) had an increase in stone size. 

Conclusion: Currently, USD is not rare in children with increasing in diagnostic methods. We believe that the detection and treatment of metabolic causes, reduce the stone recurrence, the requirement for surgical procedures, and ESRD in affected children. 

Keywords

Urinary stone disease, urine analysis, childhood, clinical characteristic

Çocuklarda üriner sistem taşı klinik görünümü ve metabolik özellikleri: Tek merkez deneyimi

Abstract

Amaç: Çalışmamızda hastanemize üriner sistem taş hastalığı (ÜSTH) saptanarak başvuran çocukların demografik özellikleri, metabolik etyolojileri ve tedaviye yanıt-larının değerlendirilmesi amaçlanmıştır. 

Hastalar ve Yöntem: 01/04/2017-31/03/2018 arası Çocuk Nefroloji-Üroloji kliniklerine başvuran ÜSTH tanısı konulmuş 259 hastanın kayıtları retrospektif olarak incelenmiştir. 

Bulgular: Olguların en fazla başvuru şikayeti, başka nedenlerle yapılan ultrasonografide saptanan ÜSTH (n:100, %38.6) idi. Olguların 52’sinde (%20.1) piyüri ve idrar kültüründe üreme vardı. Hematüri 31 (%11.2) olguda saptandı. Hipositratüri (38/82) %46.3, hipomagnezüri (22/116) %13.2, hiperkalsiüri (28/225) %12.4, hiperürikozüri (17/219) %7.7, hiperokzalüri (4/76) %5.2 olguda tespit edildi. Serum vitamin D düzeyi olguların (15/259) %5.8’inde yüksekti. Taş yerleşimi en sık böbrek alt polünde (%38.2) saptandı. Medikal tedavi verilen olgu 92 (%35.5), vücut dışı şok dalga litotripsi (ESWL) yapılan 34 olgu (%13.12), diğer cerrahi girişimlerin yapıldığı olgular ise 9 (%3.74) idi. 17 olguya eş zamanlı medikal ve cerrahi tedavi uygulandı. Takibe devam eden 199 olgunun ortanca takip süresi 3 ay (en kısa 1 ay en uzun 12 ay) idi. Son takiplerinde hastaların 142’sinde (%71.35) iyileşme görülürken, 36’sında (%18.05) taş boyutunda değişiklik saptanmadı, 21’inde (%10.6) ise taş boyutunda artış mevcuttu. 

Sonuç: Günümüzde tanısal yöntemlerin artması ile çocuklarda ÜSTH’nın nadir olmadığı görülmektedir. Metabolik nedenin saptanması ve tedavisi; taş tekrarını, cerrahi işlem gereksinimini ve etkilenmiş çocuklarda SDBY azalttığı kanaatindeyiz. 

Keywords

Üriner sistem taşı, İdrar analizi, Çocukluk çağı, idrar analizi

References

• 1. Alpay H, Ozen A, Gokce I, Biyikli N. Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatr Nephrol. 2009;24(11):2203-9. PMID: 1960319
• 2. Milliner DS. Urolithiasis. In: Avner ED, Harman WE, Niavdet P. Pediatric Nephrology (5th ed). Philadelphia: Lippincott Williams &Wilkins, 2004. p1091-1112.
• 3. Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al. Pediatric urolithiasis: developing nation perspectives. J Urol. 2002;168:1522-5. PMID: 12352448
• 4. Elder JS. Urinary lithiasis. In: Behrman ER, Kliegman MR, Jenson BH (eds). Nelson Textbook of Pediatrics, 16th ed. Philadelphia: Saunders, 2000. p1655-8.
• 5. Spivacow FR, Negri AL, del Valle EE, Calviño I, Fradinger E, Zanchetta JR. Metabolic risk factors in children with kidney stone disease. Pediatr Nephrol. 2008;23:1129-33. PMID: 18324422
• 6. Sirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol. 1995;9:549-52. PMID: 8580006
• 7. Polito C, Cioce F, La Manna A, Maiello R, Di Toro R. Renal calyceal microlithiasis: clinical presentation may precede sonographic evidence. Clin Pediatr (Phila). 1999;38(9):521-4. PMID: 10500884
• 8. Demir F, Yavuz S, Kıyak A, Aydoğan G, Korkmaz O, Sarı F.Infantil Urolithiasis: A Single Center Experience. İKSST Dergisi 2014;6(3):137-41. DOI: 10.5222/iksst.2014.137
• 9. Düşünsel R, Baştuğ F. Çocuk Nefroloji El Kitabı, Klinik Pratik Yaklaşımlar Editör: Düşünsel R. 2018. p.186
• 10. Hoppe B, Leumann E, Milliner DS. Urolithiasis and nephrocalcinosis in childhood. In: DF Geary, Schaefer F (eds). Comprehensive Pediatric Nephrology. 1st ed. Philadelphia: Elsevier, 2008. p499-525.
• 11. Sarica K. Pediatric urolithiasis: etiology, specific pathogenesis and medical treatment. Urol Res. 2006;34:96-101. PMID: 16432692
• 12. Melek E, Gülleroğlu KŞ, Bayrakçı US. Clinical and Metabolic features of Kidney Stones in Children. Türkiye Çocuk HastDerg/Turkish J Pediatr Dis/ 2016;1:40-5. DOI: 10.12956/tjpd.2015.168
• 13. Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol 2010;25:403–13. PMID: 19104842
• 14. Bak M, Ural R, Agin H, Serdaroglu E, Calkavur S. The metabolic etiology of urolithiasis in Turkish children. Int Urol Nephrol 2009;41:453-60. PMID: 19184515
• 15. Gürgöze MK, Sarı MY. Results of medical treatment and metabolic risk factors in children with urolithiasis. Pediatr Nephrol 2011;26:933-7. PMID: 21340610
• 16. Kara A, Gurgoze MK, Gozutok AU. Metabolic evaluation of children with urolithiasis. Firat Med J 2018;23(3):142-5.
• 17. Issler N, Dufek S, Kleta R, Bockenhauer D, Smeulders N, Hoff W. Epidemiology of paediatric renal Stone disease: a 22-year single centre experience in the UK. BMC Nephrol 2017;18:136. PMID: 28420322
• 18. Van Dervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M,et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 2007;177: 2300-5. PMID: 17509344
• 19. Öner A, Demircin G, Ipekçioglu H, Bulbul M, Ecin N. Etiological and clinical patterns of urolithiasis in Turkish children. EurUrol 1997;31:453-8. PMID: 9187907
• 20. Çetin N, Yıldız B, Kural N, Durmuş Aydoğdu S. Çocuklarda böbrek taşları: Eskişehir’den bir merkezin bulguları. Çocuk Sağlığı ve Hastalıkları Dergisi 2013;56:8-11.
• 21. Ozokutan BH, Küçükaydın M, Gündüz Z, Kabaklıoğlu M, Okur H, Turan C.Urolithiasis in childhood. Pediatr SurgInt 2000;16:60-3. PMID: 10663838
• 22. Sepahi MA, Heidari A, Shajari A. Clinical manifestations and etiology of renal stones in children less than 14 years age. Saudi J Kidney Dis Transpl 2010;21:181-4. PMID: 20061721
• 23. Naseri M, Varasteh AR, Alamdaran SA. Metabolic factors associated with urinary calculi in children. Iran J KidneyDis 2010;4:32-38. PMID: 20081302
• 24. Schaeffer AJ, Feng Z, Trock BJ, Mathews RI, Neu AM, Gearhart JP, et al. Medical comorbidities associated with pediatric kidney Stone disease. Urology 2011;77:195-9. PMID: 20970831
• 25. Baysal YE, Koyun M, Akman S, Güven AG, Güntekin E. Çocuklarda ürolitiyazis: Antalya yöresinde 10 yıllık deneyim. Çocuk Sağlığı ve Hastalıkları Dergisi 2004;47:254-9.
• 26. Daudon M, Jungers P. Drug induced renal calculi: epidemiology, prevention and management. Drugs 2004;64:245-75. PMID: 14871169
• 27. Sternberg K, Greenfield SP, Williot P, Wan J. Pediatric Stone disease: an evolving experience. J Urol2005;174:1711-4. PMID: 16148688
• 28. Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S,et al. Epidemiology of paediatric renal Stone disease in the UK. Arch Dis Child 2003;88(11):962-5. PMID: 14612355
• 29. Elmacı AM, Ece A, Akın F. Pediatric urolithiasis: Metabolic risk factors and follow-up results in a Turkish region with endemic Stone disease. Urolithiasis 2014;42(5):421-6. PMID: 25022263
• 30. Stableton FB. Childhood stones. Endocrinol Metab Clin North Am 2002;31:1001-15. PMID: 12474642
• 31. Dursun I, Poyrazoglu HM, Dusunsel R, Gunduz Z, Gurgoze MK, Demirci D, et al. Pediatric urolithiasis: an 8-year experience of single centre. IntUrolNephrol 2008;40:3-9. PMID: 17611811
• 32. La Manna A, Polito C, Cioce F, Maria G, Capacchione A, Rocco CE, et al. Calyceal microlit¬hiasis in children. Pediatr Nephrol 1998;12:214-7. PMID: 9630040