Pediatric stone disease
Urinary stone disease is less common in children than adults. Although many aspects of pediatric stone disease are similar to that of adults, there are unique concerns regarding the presentation, diagnosis, and management of stone disease in children. We present a review of the increasing prevalence of pediatric stone disease, the diagnostic concerns specific to children, recent results from pediatric series regarding the expectant management and surgical treatment of stones, metabolic evaluation, and current research on the genetics of nephrolithiasis.
Available from: Kristin Bergsland
- "One would assume that such inhibition would slow and even stop CaOx initial crystallization, and that loss of inhibition with age might permit stone formation to increase. It is certainly true that stone rates are much higher among adults than unselected children [36;37], and because IH is inherited the trait is present from birth; therefore our findings suggest a possible reason why a fixed risk factor – hypercalciuria – might manifest its consequence – stone formation – increasingly with age. However, we were unable to detect any differences in growth retardation between our three groups, so at least this one assay fails to provide any insight as to why stones formed in these children compared to their siblings and normal children. "
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ABSTRACT: Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence, treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone-forming children, we compared chemical measurements and the crystallization properties of 24-h urine collections from 129 stone formers matched to 105 non-stone-forming siblings and 183 normal, healthy children with no family history of stones, all aged 6 to 17 years. The principal risk factor for calcium stone formation was hypercalciuria. Stone formers have strikingly higher calcium excretion along with high supersaturation for calcium oxalate and calcium phosphate, and a reduced distance between the upper limit of metastability and supersaturation for calcium phosphate, indicating increased risk of calcium phosphate crystallization. Other differences in urine chemistry that exist between adult stone formers and normal individuals such as hyperoxaluria, hypocitraturia, abnormal urine pH, and low urine volume were not found in these children. Hence, hypercalciuria and a reduction in the gap between calcium phosphate upper limit of metastability and supersaturation are crucial determinants of stone risk. This highlights the importance of managing hypercalciuria in children with calcium stones.
Available from: Cevahir Ozer
- "Yazarlar bu baarl derlemeden dolay kutladktan sonra yaz ile ilgili bir katkda bulunmak istiyorum.bulunma- maktadr.[3,4]Kaynaklar "
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ABSTRACT: Paediatric nephrolithiasis is quite challenging in terms of management because of the smaller size of the urinary tract and the bigger risk for stone recurrence. Children bear a higher risk of metabolic and infectious causes of stone disease and a longer lifetime risk for recurrence, especially in cases of residual fragments. Complete stone clearance should become the absolute objective and clinically insignificant residual fragments should be avoided. Nowadays, percutaneous nephrolithotomy (PCNL) arises as a logical first-line treatment option for considerable paediatric nephrolithiasis as miniaturization of endoscopes and advances in energy sources for stone fragmentation have facilitated stone-free rates. In this review we present the evolution of PCNL in children and we demonstrate its safety and efficacy. As appropriate instruments are available and relevant surgical experience is accumulating, age should no longer exist as a limiting factor for performing PCNL.
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