Clinical course of pediatric urolithiasis: follow-up data in a long-term basis

Department of Urology, Yeditepe University Medical School, Devlet yolu Ankara Cad. 102/104, 34752, Kozyataği, Istanbul, Turkey.
International Urology and Nephrology (Impact Factor: 1.29). 03/2011; 43(1):7-13. DOI: 10.1007/s11255-010-9791-y
Source: PubMed

ABSTRACT To evaluate the natural course of the stone disease in pediatric patients from different perspectives among which the spontaneous passage and stone recurrence rates evaluated during the follow-up.
A total of 142 children referring with primary urinary stone disease were evaluated and followed. All children in the study were divided into two groups with respect to the age (Group 1: 0-5 years and Group 2: 6-15 years). Children were followed with respect to spontaneous passage rates, recurrence-regrowth rates, physical as well as the renal growth rates.
Stone recurrence has been noted in 44% of patients in group 1, this value was 31% in group 2. Children with at least one identifiable metabolic abnormality tended to have higher recurrence rates than the others despite conservative measures. The average stone recurrence rate in children without any metabolic abnormality was 14% and nearly 50% in children with an identifiable metabolic abnormality.
We may emphasize that due to the high recurrence and re-growth rates, all children with urinary stone disease should be followed closely with regular visits. The evaluation of metabolic risk factors in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of pre-existing calculi.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the metabolic risk factors and investigate the effect of prophylaxis based on these factors on long-term recurrence of urolithiasis in pediatric patients with hypocitraturia. One-hundred and twenty-nine pediatric patients who underwent percutaneous nephrolithotomy between January 2008 and June 2011 were evaluated for metabolic risk factors. The patients with hypocitraturia were enrolled in this study and the data were analyzed using statistical methods for a mean period of 2 years for metabolic abnormalities, stone type, and the effect of potassium citrate prophylaxis on stone recurrence. A 24-h urine metabolite analysis revealed one or more metabolic risk factors in 115 (89.2 %) of the patients, whereas 14 (10.8 %) of the patients had no metabolic abnormalities. Eighty-two (63.5 %) of 129 patients had hypocitraturia. Of them, 43 (52 %) were male and 39 (48 %) were female, with a mean age of 9.7 ± 4.9 and 6.7 ± 4.4 (1-16) years, respectively(p = 0.102). Thirty-five (42.7 %) had pure hypocitraturia, and 47 (57.3 %) had two or more metabolic abnormalities. The most common dual metabolic abnormality was hypocitraturia and hypomagnesuria. Seventy-one patients (87 %) with hypocitraturia received medical prophylaxis and continued regularly, whereas 11 (13 %) patients did not receive medical prophylaxis despite being advised to do so. After a mean follow-up of 26.5 ± 9.4 months, the rate of recurrence was 1.4 % in the patients with hypocitraturia who continued prophylaxis and occurred in all of the patients who did not receive prophylaxis (p < 0.001). Calcium oxalate stones (95.2 %) were the most commonly found stones in the stone analysis. Detailed clinical and laboratory evaluations should be performed in children with urolithiasis. Appropriate prophylactic treatment as potassium citrate, should be given to prevent reformation of stones in patient with hypocitraturia.
    Urolithiasis 02/2013; 41(1):9-13. DOI:10.1007/s00240-012-0539-2
  • [Show abstract] [Hide abstract]
    ABSTRACT: To provide insight in causative factors of pediatric urolithiasis in The Netherlands, a non-endemic country. Data from 71 children with urolithiasis and stone analyses between 1996 and 2010 in the Radboud University Nijmegen Medical Centre were studied retrospectively. Patients (48 boys, 23 girls, ratio 2.1:1) were aged 0.5-18.3 years (mean 8.8, SD 5.6). All stone analyses were performed with FTIR spectroscopy. Of the 49 patients with metabolic analysis, 78% showed one (n = 15) or more (n = 23) metabolic abnormalities. Forty-seven percent had hypercalciuria (n = 23), 31% had hyperoxaluria (n = 15), 29% hypocitraturia (n = 14), 10% hyperuricosuria (n = 5), 10% cystinuria (n = 5), and 6% had hypomagnesiuria (n = 3). Sixty-one percent of the stones were composed of calcium phosphate, calcium oxalate, or a combination of those. Twenty-six percent consisted of pure or mixed magnesium ammonium phosphate, 8.3% pure or mixed urate, and 8.3% cystine. Children with urolithiasis in The Netherlands show stone composition similar to other Western European countries. However, a high percentage of metabolic abnormalities (78%) was found, indicating the need for extensive evaluation of pediatric urolithiasis to find underlying causes and thereby prevent stone recurrences. A close collaboration between a pediatric nephrologist and urologist is mandatory for optimal surgical and medical treatment.
    Journal of pediatric urology 08/2013; 10(1). DOI:10.1016/j.jpurol.2013.07.019 · 1.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the causes of urolithiasis in Uyghur children from Xinjiang. We retrospectively evaluated the clinical features and characteristics of urinary stone composition of 220 Uyghur pediatric patients with urolithiasis between March 2009 and June 2011. The data were compared with that of 100 Uyghur children without urolithiasis who visited the Child Care Clinic for regular health check-ups. The stones were collected by endoscopy or open surgery, and analyzed using infrared spectroscopy. The mean age of the 220 Uyghur children was 7.48 ± 4.73 years (range, 0.8-17.0 years). The overall sex ratio (male:female) was 2.23:1. The predominant pure stone was ammonium urate (58.9%), whereas the predominant mixed stone was calcium oxalate mixture (91.1%). Uric acid stones comprised 54% of all stones. Urinary tract infections were observed in 42.3% and 4.0% of the patient and control groups, respectively. The mean urinary pH values were 5.77 ± 0.67 and 6.42 ± 0.67, respectively (p < 0.001). pH values were <5.5 in 52.7% and 6% of the patient and control groups, respectively. On 24-h urine analysis, we found metabolic disturbances in these patients: hypercalciuria in 6.8% cases, hyperphosphaturia in 16.8% cases, hyperuricosuria in 21.4% cases, and hypomagnesiuria in 34.1% cases. Urolithiasis in Uyghur children may be primarily related to local environmental factors.
    Journal of pediatric urology 09/2013; 10(2). DOI:10.1016/j.jpurol.2013.09.002 · 1.41 Impact Factor
Show more