Skip to main content
SpringerLink
Log in

A new approach to the diagnosis of children’s urolithiasis based on the Bonn Risk Index

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Published data on the association between calcium oxalate (CaOx) crystallization and kidney stone disease in children are scarce. The aims of this study were to determine CaOx crystallization using the Bonn Risk Index (BRI) in children with urolithiasis in comparison to healthy controls, to evaluate the relationships between BRI and urinary parameters, such as pH, calciuria, oxaluria and citraturia, and to assess the association between BRI and the size of renal stones. We compared the BRI in 142 Caucasian children and adolescents (76 girls, 66 boys) aged 3–18 years with kidney stones and 210 healthy age- and sex-matched controls without urolithiasis. Urinary ionized calcium ([Ca2+]) was measured using a selective electrode, while the onset of spontaneous crystallization was determined using a photometer and titration with 40 mmol/L ammonium oxalate (Ox2−). The calculation of the BRI value was based on the Ca2+:Ox2− ratio. High-resolution renal ultrasonography was carried out to estimate the size of the renal stones. The BRI values were 15-fold higher in children with renal stones than in healthy children without stones. The same trend was shown by BRI/kg body weight (tenfold greater in children with renal stones than in healthy children without stones), BRI/per 1.73 m2 body surface (13-fold greater) and BRI/body mass index (23-fold greater). No association was observed between BRI and the diameter of stones. Children with kidney stones, both males and females, had an increased BRI compared with subjects without urolithiasis. High BRI suggests an association with lower urinary pH, hypercalciuria, hyperoxaluria or hypocitraturia, which are all risk factors of kidney stones. An increased BRI in children, although unrelated to renal stone size, reflects the risk of calcium oxalate crystallization and may indicate early metabolic disorders leading to urolithiasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pak CY (1998) Kidney stones. Lancet 351:1797–1801

    Article  CAS  PubMed  Google Scholar 

  2. Hoppe B, Leumann E, von Unruh G, Laube N, Hesse A (2003) Diagnostic and therapeutic approaches in patients with secondary hyperoxaluria. Front Biosci 8:437–443

    Article  Google Scholar 

  3. Trinchieri A, Ostini F, Nespoli R, Rovera F, Zanetti G (1999) A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol 162:27–30

    Article  CAS  PubMed  Google Scholar 

  4. Sutherland JW, Parks JH, Coe FL (1985) Recurrence after a single renal stone in a community practice. Miner Electrolyte Metab 11:267–269

    CAS  PubMed  Google Scholar 

  5. Cameron MA, Sakhaee K, Moe OW (2005) Nephrolithiasis in children. Pediatr Nephrol 20:1587–1592

    Article  PubMed  Google Scholar 

  6. Kraus SJ, Lebowitz RL, Royal SA (1999) Renal calculi in children: imaging features that lead to diagnoses: a pictorial essay. Pediatr Radiol 29:624–630

    Article  CAS  PubMed  Google Scholar 

  7. Tiselius HG (1997) Risk formulas in calcium oxalate urolithiasis. World J Urol 15:176–185

    Article  CAS  PubMed  Google Scholar 

  8. Kavanagh JP, Laube N (2006) Why does the Bonn Risk Index discriminate between calcium oxalate stone formers and healthy controls? J Urol 175:766–770

    Article  PubMed  Google Scholar 

  9. Werness PG, Brown CM, Smith LH, Finlayson B (1985) EQUIL 2: a basic computer program for the calculation of urinary saturation. J Urol 134:1242–1244

    Article  CAS  PubMed  Google Scholar 

  10. DeFoor W, Asplin J, Jackson E, Jackson C, Reddy P, Sheldon C, Erhard M, Minevich E (2006) Urinary metabolic evaluations in normal and stone forming children. J Urol 176:1793–1796

    Article  PubMed  Google Scholar 

  11. Laube N, Schneider A, Hesse A (2000) A new approach to calculate the risk of calcium oxalate crystallization from unprepared native urine. Urol Res 28:274–280

    Article  CAS  PubMed  Google Scholar 

  12. Laube N, Hergarten S, Hesse A (2002) Comparison of a laser-probe and photometric determination of the urinary crystallization risk of calcium oxalate. Clin Chem Lab Med 40:595–599

    Article  CAS  PubMed  Google Scholar 

  13. Laube N, Labedzke V, Hergarten S, Hesse A (2002) Determination of urinary calcium-oxalate formation risk with BONN-Risk-Index and EQUIL applied to a family. J Chem Inf Comput Sci 42:633–639

    Article  CAS  PubMed  Google Scholar 

  14. Lewandowski S, Rodgers AL, Laube N, von Unruh G, Zimmermann D, Hesse A (2005) Oxalate and its handling in a low stone risk vs a stone-prone population group. World J Urol 6:1–4

    Google Scholar 

  15. Porowski T, Zoch-Zwierz W, Wasilewska A, Spotyk A, Konstantynowicz J (2007) Normative data on the Bonn Risk Index for calcium oxalate crystallization in healthy children. Pediatr Nephrol 22:514–520

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kunachowicz H, Nadolna I, Przygoda B, Iwanow K (eds) (1998) Food composition tables. National Food and Nutrition Institute, Warsaw

  17. VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, Trachtman H (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305

    Article  PubMed  Google Scholar 

  18. Pietrow PK, Pope JC 4th, Adams MC, Shyr Y, Brock JW 3rd (2002) Clinical outcome of pediatric stone disease. J Urol 167:670–673

    Article  PubMed  Google Scholar 

  19. Kroovand RL (1997) Pediatric urolithiasis. Urol Clin North Am 24:173–184

    Article  CAS  PubMed  Google Scholar 

  20. Tefekli A, Esen T, Ziylan O, Erol B, Armagan A, Ander H, Akinci M (2003) Metabolic risk factors in pediatric and adult calcium oxalate urinary stone formers: is there any difference? Urol Int 70:273–277

    Article  CAS  PubMed  Google Scholar 

  21. Erbagci A, Erbagci AB, Yilmaz M, Yagci F, Tarakcioglu M, Yurtseven C, Koyluoglu O, Sarica K (2003) Pediatric urolithiasis—evaluation of risk factors in 95 children. Scand J Urol Nephrol 37:129–133

    Article  CAS  PubMed  Google Scholar 

  22. Laube N, Hergarten S, Hoppe B, Schmidt M, Hesse A (2004) Determination of the calcium oxalate crystallization risk from urine samples: the Bonn Risk Index in comparison to other risk formulas. J Urol 172:355–359

    Article  CAS  PubMed  Google Scholar 

  23. Teller WM, Burke EC, Rosevear JW, McKenzie BF (1962) Urinary excretion of acid mucopolysaccharides in normal children and patients with gargoylism. J Lab Clin Med 59:95–101

    CAS  PubMed  Google Scholar 

  24. Bergsland KJ, Kinder JM, Asplin JR, Coe BJ, Coe FL (2002) Influence of gender and age on calcium oxalate crystal growth inhibition by urine from relatives of stone forming patients. J Urol 167:2372–2376

    Article  CAS  PubMed  Google Scholar 

  25. Ricchiuti V, Hartke DM, Yang LZ, Goldman HB, Elder JS, Resnick MI, Marengo SR (2002) Levels of urinary inter-alpha-trypsin inhibitor trimer as a function of age and sex-hormone status in males and females not forming stones. BJU Int 90:513–517

    Article  CAS  PubMed  Google Scholar 

  26. Moe OW, Preisig PA (2006) Dual role of citrate in mammalian urine. Curr Opin Nephrol Hypertens 15:419–424

    Article  CAS  PubMed  Google Scholar 

  27. Halperin ML, Cheema Dhadli S, Kamel KS (2006) Physiology of acid-base balance: Links with kidney stone prevention. Semin Nephrol 26:441–446

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. First Department of Pediatrics, Medical University of Bialystok, Bialystok, Poland

    Tadeusz Porowski, Walentyna Zoch-Zwierz & Katarzyna Taranta-Janusz

  2. Department of Pediatrics and Auxology, Bone Densitometry Unit, ‘Dr L. Zamenhof’ University Children’s Hospital, Medical University of Bialystok, Waszyngtona St. 17, 15274, Bialystok, Poland

    Jerzy Konstantynowicz

Authors
  1. Tadeusz Porowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walentyna Zoch-Zwierz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerzy Konstantynowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katarzyna Taranta-Janusz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jerzy Konstantynowicz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Porowski, T., Zoch-Zwierz, W., Konstantynowicz, J. et al. A new approach to the diagnosis of children’s urolithiasis based on the Bonn Risk Index. Pediatr Nephrol 23, 1123–1128 (2008). https://doi.org/10.1007/s00467-008-0786-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-008-0786-1

Keywords

Search

Navigation