Advertisement

Urolithiasis

, Volume 46, Issue 5, pp 445–452 | Cite as

Composition of urinary calculi in infants: a report from an endemic country

  • Mirza Naqi Zafar
  • Salma Ayub
  • Hafsa Tanwri
  • Syed Ali Anwar Naqvi
  • Syed Adibul Hasan Rizvi
Original Paper

Abstract

Pediatric urolithiasis remains endemic in low-resource countries where infants constitute 17–40% of all children with urolithiasis. This study reports socio-economic factors, medical history and chemical composition of urinary stones in 976 infants of up to 2 years of age. Between 1992 and 2016, 976 infants presented to our institute with 1038 stones. Chemical composition of stones was analyzed by Fourier transformation infrared spectroscopy (FTIR). The mean age of infants was 19.5 ± 5.74 months with a M:F ratio of 5.5:1. Half (50%) of the infants were rural dwellers, 90% belonged to low socio-economic class and 70% were malnourished. A history of chronic diarrhoea was reported in 13% and urinary tract infections in 5%. The anatomic location was bladder in 487 (46.9%), kidney in 246 (23.6%), ureter in 142 (13.6%), urethra in 2 (0.2%) and 161 (15.5%) were passed spontaneously. Overall frequency of compounds in stones showed ammonium acid urate (AAU) in 772 (74.37%), calcium oxalate (CaOx) in 410 (39.5%). Uric acid (UA) in 119 (11.46%), calcium phosphate apatite (CaP) in 96 (9.25%), magnesium ammonium phosphate (Struvite) in 45 (4.34%), cystine in 12 (1.16%) and xanthine in 40 (3.85%). Frequency of compounds was similar in genders. Infants of age 0–6 months had higher frequency of UA (28%), CaOx (50%) and low AAU (61%) as compared to 11, 39 and 75%, respectively, in 7–24 months (p < 0.049) (p < 0.002) (p < 0.001). Nucleus of stones showed pure AAU in 63 and 43% on the surface due to addition of CaOx, struvite and CaP. Our study has shown that AAU is a major component of stones in infants where the main risk factors are poverty, malnutrition, diarrheal diseases and dehydration.

Keywords

Urinary Stones Infants Chemical composition 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, Sultan S, Mehdi H (2002) Pediatric urolithiasis: developing nation perspectives. J Urol 168(4 Pt 1):1522–1525CrossRefPubMedGoogle Scholar
  2. 2.
    Alpay H, Ozen A, Gokce I, Biyikli N (2009) Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatr Nephrol 24(11):2203–2209CrossRefPubMedGoogle Scholar
  3. 3.
    Güven AG, Koyun M, Baysal YE, Akman S, Alimoglu E, Akbas H, Kabaalioglu A (2010) Urolithiasis in the first year of life. Pediatr Nephrol 25(1):129–134CrossRefPubMedGoogle Scholar
  4. 4.
    Alaya A, Nouri A, Najjar MF (2011) Urinary stone composition in pediatric patients: a retrospective study of 205 cases. Clin Chem Lab Med 49(2):243–248CrossRefPubMedGoogle Scholar
  5. 5.
    Ali SH, Rifat UN (2005) Etiological and clinical patterns of childhood urolithiasis in Iraq. Pediatr Nephrol 20(10):1453–1457CrossRefPubMedGoogle Scholar
  6. 6.
    Huang WY, Chen YF, Chen SC, Lee YJ, Lan CF, Huang KH (2012) Pediatric urolithiasis in Taiwan: a nationwide study, 1997–2006. Urology 79(6):1355–1359CrossRefPubMedGoogle Scholar
  7. 7.
    Routh JC, Graham DA, Nelson CP (2010) Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals. J Urol 184(3):1100–1104CrossRefPubMedGoogle Scholar
  8. 8.
    Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, van’t Hoff WG (2003) Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 88(11):962–965CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Milošević D, Batinić D, Turudić D, Batinić D, Topalović-Grković M, Gradiški IP (2014) Demographic characteristics and metabolic risk factors in Croatian children with urolithiasis. Eur J Pediatr 173(3):353–359CrossRefPubMedGoogle Scholar
  10. 10.
    López M, Hoppe B (2010) History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol 25(1):49–59CrossRefPubMedGoogle Scholar
  11. 11.
    Clayton DB, Pope JC (2011) The increasing pediatric stone disease problem. Ther Adv Urol 3(1):3–12CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rizvi SA, Sultan S, Zafar MN, Ahmed B, Faiq SM, Hossain KZ, Naqvi SA (2007) Evaluation of children with urolithiasis. Indian J Urol 23(4):420–427CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hesse A, Sanders G, Stuttgart V (1988) Atlas of infrared spectra for the analysis of urinary concernments, New YorkGoogle Scholar
  14. 14.
    WHO Anthro Software. http://www.who.int/childgrowth/software/en/. Accessed 21 Sept 2017
  15. 15.
    Alaya A, Nouri A, Najjar MF (2010) Changes in stone composition according to age and gender in Tunisian children. J Pediatr Urol 6(4):364–371CrossRefPubMedGoogle Scholar
  16. 16.
    Baştuğ F, Gündüz Z, Tülpar S, Poyrazoğlu H, Düşünsel R (2013) Urolithiasis in infants: evaluation of risk factors. World J Urol 31(5):1117–1122CrossRefPubMedGoogle Scholar
  17. 17.
    Azili MN, Ozturk F, Inozu M, Çayci FŞ, Acar B, Ozmert S, Tiryaki T (2015) Management of stone disease in infants. Urolithiasis 43(6):513–519CrossRefPubMedGoogle Scholar
  18. 18.
    Gabrielsen JS, Laciak RJ, Frank EL, McFadden M, Bates CS, Oottamasathien S, Hamilton BD, Wallis MC (2012) Pediatric urinary stone composition in the United States. J Urol 187(6):2182–2187CrossRefPubMedGoogle Scholar
  19. 19.
    Kit LC, Filler G, Pike J, Leonard MP (2008) Pediatric urolithiasis: experience at a tertiary care pediatric hospital. Can Urol Assoc J 2(4):381–386CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kirejczyk JK, Porowski T, Filonowicz R, Kazberuk A, Stefanowicz M, Wasilewska A, Debek W (2014) An association between kidney stone composition and urinary metabolic disturbances in children. J Pediatr Urol 10(1):130–135CrossRefPubMedGoogle Scholar
  21. 21.
    Wu W, Yang B, Ou L, Liang Y, Wan S, Li S, Zeng G (2014) Urinary stone analysis on 12,846 patients: a report from a single center in China. Urolithiasis 42(1):39–43CrossRefPubMedGoogle Scholar
  22. 22.
    Rellum DM, Feitz WF, van Herwaarden AE, Schreuder MF (2014) Pediatric urolithiasis in a non-endemic country: a single center experience from The Netherlands. J Pediatr Urol 10(1):155–161CrossRefPubMedGoogle Scholar
  23. 23.
    Human development Report (2014) Health: children and youth. United Nations Development Programme (UNDP), New York, USA, pp 184–187. http://hdr.undp.org/sites/default/files/hdr14-report-en-1.pdf. Accessed 21 Sept 2017
  24. 24.
    Soliman NA, Rizvi SAH (2016) Endemic bladder calculi in children. Pediatr Nephrol.  https://doi.org/10.1007/s00467-016-3492-4 CrossRefPubMedGoogle Scholar
  25. 25.
    Alaya A, Belgith M, Hammadi S, Nouri A, Najjar MF (2012) Kidney stones in children and teenagers in the central coast region of Tunisia. Iran J Pediatr 22(3):290–296PubMedPubMedCentralGoogle Scholar
  26. 26.
    Selimoğlu MA, Menekşe E, Tabel Y (2013) Is urolithiasis in children associated with obesity or malnutrition? J Ren Nutr 23(2):119–122CrossRefPubMedGoogle Scholar
  27. 27.
    Alaya A, Nouri A, Najjar MF (2010) Paediatric urolithiasis in central coast region of Tunisia: changes in stone composition according to age and gender. Arch Ital Urol Androl 82(3):135–139PubMedGoogle Scholar
  28. 28.
    Alpay H, Gokce I, Özen A, Bıyıklı N (2013) Urinary stone disease in the first year of life: is it dangerous? Pediatr Surg Int 29(3):311–316CrossRefPubMedGoogle Scholar
  29. 29.
    Elmacı AM, Ece A, Akın F (2014) Pediatric urolithiasis: metabolic risk factors and follow-up results in a Turkish region with endemic stone disease. Urolithiasis 42(5):421–426CrossRefPubMedGoogle Scholar
  30. 30.
    Hazir T, Akram DS, Nisar YB, Kazmi N, Agho KE, Abbasi S, Khan AM, Dibley MJ (2013) Determinants of suboptimal breast-feeding practices in Pakistan. Public Health Nutr 16(4):659–672CrossRefPubMedGoogle Scholar
  31. 31.
    Nisar MU, Anwar Ul Haq MM, Tariq S, Anwar M, Khawar A, Waqas A, Nisar A (2016) Feeding patterns and predictors of malnutrition in infants from poor socioeconomic areas in Pakistan: a cross-sectional survey. Cureus 8(1):e452PubMedPubMedCentralGoogle Scholar
  32. 32.
    Tamošaitytė S, Hendrixson V, Želvys A, Tyla R, Kučinskienė ZA, Jankevičius F, Pučetaitė M, Jablonskienė V, Šablinskas V (2013) Combined studies of chemical composition of urine sediments and kidney stones by means of infrared microspectroscopy. J Biomed Opt 18(2):27011CrossRefPubMedGoogle Scholar
  33. 33.
    Primiano A, Persichilli S, Gambaro G, Ferraro PM, D’Addessi A, Cocci A, Schiattarella A, Zuppi C, Gervasoni J (2014) FT-IR analysis of urinary stones: a helpful tool for clinician comparison with the chemical spot test. Dis Markers 2014:176165CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Mirza Naqi Zafar
    • 1
  • Salma Ayub
    • 1
  • Hafsa Tanwri
    • 1
  • Syed Ali Anwar Naqvi
    • 2
  • Syed Adibul Hasan Rizvi
    • 2
  1. 1.Department of PathologySindh Institute of Urology and TransplantationKarachiPakistan
  2. 2.Department of UrologySindh Institute of Urology and TransplantationKarachiPakistan

Personalised recommendations