Urinary Lithiasis in Children — A Review of 100 Cases

Abstract

From 1970 to 1979, 100 cases of urinary lithiasis have been referred to our service in the Hôpital des Enfants Malades. Sixty two were boys and 38 were girls, the usual sex ratio for stone disease in children. Age at diagnosis was below 2 years in 33 cases and below 5 years in 60 cases. The presenting symptoms were the following: hematuria (20 cases), pyuria (19 cases), abdominal pain or colic (18 cases), passage of a calculus (11 cases), proteinuria (10 cases), incidental finding on abdominal x-ray (4 cases), urinary retention (3 cases), renal mass (3 cases) and anuria (3 cases). The frequency of these symptoms varied according to age: below 2 years pyuria was the most frequent, between 2 and 5 years hematuria and above 5 years, pain and colic.

Various etiologies were found in this series. In 34 cases a metabolic cause was found, and in 12 cases urinary tract abnormalities existed prior to lithiasis. 54 cases remained idiopathic despite full investigations.

Idiopathic lithiasis seems to have become less frequent in the last five years since we have seen only 15 cases as compared with 28 cases in the five years before. Stones were generally located in the renal pelvis or the ureter. Only 3 cases had bladder stones, 2 of whom came from tropical areas. Thirty five of these children were successfully operated upon but recurrence of stones was observed in 2 cases who subsequently underwent a second operation. The other 19 were treated medically and a few small stones were passed spontaneously. In the latter group only one recurrence was observed.

The frequency of metabolic causes is probably over-estimated in this series due to the specialised nature of our service.

Primary hyperoxaluria (11 cases) was the most frequent, followed by familial cystinuria-lysinuria (7 cases) and by oxalic lithiasis with a mild hyperoxaluria (6 cases). Two cases had hyperuricemia (related to Lesch-Nyhan disease) and two others developed xanthine stones after cytolytic treatment for malignant disease. Finally, six cases had hypercalciuria. One had a distal tubular acidosis of Albright type, one had primary hyperparathyroidism, one developed stones after long term steroid and vit D therapy, one was immobilised in a cast and two had idiopathic hypercalciuria of renal type.

The last group of patients (12 cases) developed stones in association with a preexisting urinary tract abnormality of whom 2 had pyelo-ureteral stenosis and 2 mega ureters with reflux. Four patients who had unilateral stones in a non-functioning kidney were classified after histological study as having xanthogranulomatous pyelonephritis.