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Clinical and metabolic features of urolithiasis and microlithiasis in children

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Abstract

We evaluated the clinical, radiological and metabolic features of 162 children with urolithiasis or microlithiasis who had been referred to our pediatric nephrology clinics between 1998 and 2008 with suspected urolithiasis. The medical histories of these children (78 girls, 84 boys), who ranged in age from 2 months to 16 years (mean age 5.59 ± 0.35 years), were reviewed retrospectively for clinical and metabolic features of urinary tract calculi. Urinary tract infections (UTI) were present in 45.9% of the cases. The most common presenting symptoms were flank pain or restlessness (25.3%) and hematuria (21.6%), followed by UTI (16%), whereas 23.5% of the cases were detected incidentally during evaluation for other medical conditions. Other symptoms at presentation included dysuria, passing stones, penile edema, enuresis, vomiting and anorexia. Urine analysis revealed metabolic abnormalities in 87% of the cases, including hypercalciuria (33.8%), hypocitraturia (33.1%), hyperoxaluria (26.5%), hyperuricosuria  (25.4%), hypocitraturia + hypercalciuria (21.1%), hyperphosphaturia  (20.8%) and cystinuria (5.7%). Almost 50% of the patients had a positive family history for urolithiasis. The most frequently involved site was in the kidneys (86%). Ureters and bladder were involved in 12 and 2% of the cases, respectively. A family history of urolithiasis, presenting symptoms and underlying metabolic abnormalities were similar for microlithiasis and the patients with larger stones. However, in our study population, microlithiasis was mainly a disease of young infants, with a greater chance for remission and often not associated with structural changes. The presenting symptoms of urolithiasis show a wide spectrum, so that a high index of suspicion is important for early detection. A metabolic abnormality can be identified in 87% of cases of urolithiasis. Detection of microlithiasis may explain a number of symptoms, thus reducing invasive diagnostic procedures and allowing early recognition of metabolic abnormalities. These results draw attention to the importance of screening for UTIs in patients with urolithiasis.

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References

  1. Walther PC, Lamm D, Kaplan GW (1980) Pediatric urolithiases: a ten-year review. Pediatrics 65(6):1068–1072

    CAS  PubMed  Google Scholar 

  2. Troup CW, Lawnicki CC, Bourne RB, Hodgson NB (1972) Renal calculus in children. J Urol 107(2):306–307

    CAS  PubMed  Google Scholar 

  3. Remzi D, Cakmak F, Erkan I (1980) A study on the urolithiasis incidence in Turkish school-age children. J Urol 123(4):608

    CAS  PubMed  Google Scholar 

  4. Ece A, Ozdemir E, Gürkan F, Dokucu AI, Akdeniz O (2000) Characteristics of pediatric urolithiasis in south-east Anatolia. Int J Urol 7(9):330–334

    CAS  PubMed  Google Scholar 

  5. Sirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F (1995) Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 9(5):549–552

    CAS  PubMed  Google Scholar 

  6. Tekin A, Tekgul S, Atsu N, Sahin A, Ozen H, Bakkaloglu M (2000) A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk factor. J Urol 164(1):162–165

    CAS  PubMed  Google Scholar 

  7. Elder JS (2000) Urinary lithiasis. In: Behrman ER, Kliegman MR, Jenson BH (eds) Nelson textbook of pediatrics, 16th edn. Saunders, Philadelphia, pp 1655–1658

    Google Scholar 

  8. Gearhart JP, Herzberg GZ, Jeffs RD (1991) Childhood urolithiasis: experiences and advances. Pediatrics 87(4):445–450

    CAS  PubMed  Google Scholar 

  9. Polito C, Cioce F, La Manna A, Maiello R, Di Toro R (1999) Renal calyceal microlithiasis: clinical presentation may precede sonographic evidence. Clin Pediatr (Phila) 38(9):521–524

    CAS  Google Scholar 

  10. Ghazali S, Barratt TM (1974) Urinary excretion of calcium and magnesium in children. Arch Dis Child 49(2):97–101

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Stapleton FB, Noe HN, Jenkis G, Roy S 3rd (1982) Urinary excretion of calcium following an oral calcium loading test in healthy children. Pediatrics 69(5):594–597

    CAS  PubMed  Google Scholar 

  12. Srivastava T, Alon US (2005) Urolithiasis in adolescent children. Adolesc Med Clin 16(1):87–109

    PubMed  Google Scholar 

  13. Milliner DS (2004) Urolithiasis. In: Avner ED, Harman WE, Niaudet P (eds) Pediatric nephrology, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1091–1112

    Google Scholar 

  14. Bartosh SM (2004) Medical management of pediatric stone disease. Urol Clin North Am 31(3):575–587

    PubMed  Google Scholar 

  15. Choi H, Snyder HM 3rd, Duckett JW (1987) Urolithiasis in childhood: current management. J Pediatr Surg 22(2):158–164

    CAS  PubMed  Google Scholar 

  16. Malek RS, Kelalis PP (1975) Pediatric nephrolithiasis. J Urol 113(4):545–551

    CAS  PubMed  Google Scholar 

  17. Ghazali S, Barratt TM, Williams DI (1973) Childhood urolithiasis in Britain. Arch Dis Child 48(4):291–295

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Gaches GC, Gordon IR, Shore DF, Roberts JB (1975) Urinary lithiasis in childhood in the Bristol clinical area. Br J Urol 47(2):109–116

    CAS  PubMed  Google Scholar 

  19. Ozokutan BH, Kucukaydin M, Gunduz Z, Kabaklioglu M, Okur H, Turan C (2000) Urolithiasis in childhood. Pediatr Surg Int 16(1–2):60–63

    CAS  PubMed  Google Scholar 

  20. 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(6):2300–2305

    PubMed  Google Scholar 

  21. Basaklar AC, Kale N (1991) Experience with childhood urolithiasis. Report of 196 cases. Br J Urol 67(2):203–205

    CAS  PubMed  Google Scholar 

  22. 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):1522–1525

    CAS  PubMed  Google Scholar 

  23. Sarkissian A, Babloyan A, Arikyants N, Hesse A, Blau N, Leumann E (2001) Pediatric urolithiasis in Armenia: a study of 198 patients observed from 1991 to 1999. Pediatr Nephrol 16(9):728–732

    CAS  PubMed  Google Scholar 

  24. Shah AM, Kalmunkar S, Punekar SV, Billimoria FR, Bapat SD, Deshmukh SS (1991) Spectrum of pediatric urolithiasis in western India. Indian J Pediatr 58(4):543–549

    CAS  PubMed  Google Scholar 

  25. Turkey National Hemodialysis (2004) Transplantation and Nephrology Registry Report of Turkey 2003. Istanbul. Available at: http://www.tsn.org.tr/registry/Registry_2003_Tr_Eng.pdf

  26. Milliner DS, Murphy ME (1993) Urolithiasis in pediatric patients. Mayo Clin Proc 68(3):241–248

    CAS  PubMed  Google Scholar 

  27. Diamond DA, Menon M, Lee PH, Rickwood AM, Johnston JH (1989) Etiological factors in pediatric stone recurrence. J Urol 142(2 Pt 2):606–608, discussion 619

    CAS  PubMed  Google Scholar 

  28. Perrone HC, dos Santos DR, Santos MV, Pinheiro ME, Toporovski J, Ramos OL, Schor N (1992) Urolithiasis in childhood: metabolic evaluation. Pediatr Nephrol 6(1):54–56

    CAS  PubMed  Google Scholar 

  29. Lim DJ, Walker RD 3rd, Ellsworth PI, Newman RC, Cohen MS, Barraza MA, Stevens PS (1996) Treatment of pediatric urolithiasis between 1984 and 1994. J Urol 156(2 Pt 2):702–705

    CAS  PubMed  Google Scholar 

  30. Stapleton FB (1990) Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children. The Southwest Pediatric Nephrology Study Group. Kidney Int 37(2):807–811

    CAS  PubMed  Google Scholar 

  31. Baysal YE, Koyun M, Akman S, Güven AG, Güntekin E (2004) Çocuklarda ürolitiyazis: Antalya yöresinde 10 yıllık deneyim. Çocuk Sağlığı ve Hastalıkları Dergisi 47:254–259

    Google Scholar 

  32. Pietrow PK, Pope JC 4th, Adams MC, Shyr Y, Brock JW 3rd (2002) Clinical outcome of pediatric stone disease. J Urol 167(2 Pt 1):670–673

    PubMed  Google Scholar 

  33. Noe HN (2000) Hypercalciuria and pediatric stone recurrences with and without structural abnormalities. J Urol 164(3 Pt 2):1094–1096

    CAS  PubMed  Google Scholar 

  34. Dursun I, Poyrazoglu HM, Dusunsel R, Gunduz Z, Gurgoze MK, Demirci D, Kucukaydin M (2008) Pediatric urolithiasis: an 8-year experience of single centre. Int Urol Nephrol 40(1):3–9

    PubMed  Google Scholar 

  35. Faerber GJ (2001) Pediatric urolithiasis. Curr Opin Urol 11(4):385–389

    CAS  PubMed  Google Scholar 

  36. Sinno K, Boyce WH, Resnick MI (1979) Childhood urolithiasis. J Urol 121(5):662–664

    CAS  PubMed  Google Scholar 

  37. La Manna A, Polito C, Cioce F, De Maria G, Capacchione A, Rocco CE, Papale MR, Romei L (1998) Calyceal microlithiasis in children: report on 196 cases. Pediatr Nephrol 12(3):214–217

    PubMed  Google Scholar 

  38. Escribano J, Balaguer A, Martin R, Feliu A, Espax R (2004) Childhood idiopathic hypercalciuria, clinical significance of renal calyceal microlithiasis and risk of calcium nephrolithiasis. Scand J Urol Nephrol 38(5):422–426

    PubMed  Google Scholar 

  39. Polinsky MS, Kaiser BA, Baluarte HJ (1987) Urolithiasis in childhood. Pediatr Clin North Am 34(3):683–710

    CAS  PubMed  Google Scholar 

  40. Pak CY, Poindexter JR, Adams-Huet B, Pearle MS (2003) Predictive value of kidney stone composition in the detection of metabolic abnormalities. Am J Med 115(1):26–32

    CAS  PubMed  Google Scholar 

  41. Hodgkinson A (1977) Composition of urinary tract calculi in children of different ages. Br J Urol 49(6):453–455

    CAS  PubMed  Google Scholar 

  42. Scholten HG, Bakker NJ, Cornil C (1973) Urolithiasis in childhood. J Urol 109(4):744–745

    CAS  PubMed  Google Scholar 

  43. Bennett AH, Colodny AH (1973) Urinary tract calculi in children. J Urol 109(2):318–320

    CAS  PubMed  Google Scholar 

  44. Hari P, Bagga A, Vasudev V, Singh M, Srivastava RN (1995) Aetiology of nephrolithiasis in north Indian children. Pediatr Nephrol 9(4):474–475

    CAS  PubMed  Google Scholar 

  45. Kamoun A, Daudon M, Abdelmoula J, Hamzaoui M, Chaouachi B, Houissa T, Zghal A, Ben Ammar S, Belkahia C, Lakhoua R (1999) Urolithiasis in Tunisian children: a study of 120 cases based on stone composition. Pediatr Nephrol 13(9):920–925

    CAS  PubMed  Google Scholar 

  46. Fraser M, Joyce AD, Thomas DF, Eardley I, Clark PB (1999) Minimally invasive treatment of urinary tract calculi in children. BJU Int 84(3):339–342

    CAS  PubMed  Google Scholar 

  47. Ones T, Dede F, Gokce I, Biyikli N, Erdil Y, Turoglu T, Alpay H (2007) DMSA findings in children with urolithiasis and urinary tract infections. Eur J Nucl Med Imaging 34[Suppl]:S367

    Google Scholar 

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Acknowledgments

We thank Dr. Ray W. Guillery for his help with editing our manuscript.

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  1. Harika Alpay

    Present address: Tophanelioğlu Caddesi No: 13/15 34662 Altunizade, Istanbul, Turkey

Authors and Affiliations

  1. Department of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey

    Harika Alpay, Ibrahim Gokce & Nese Biyikli

  2. Department of Pediatrics, Yeditepe University Medical Faculty, Istanbul, Turkey

    Ahmet Ozen

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  1. Harika Alpay
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Correspondence to Harika Alpay.

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Alpay, H., Ozen, A., Gokce, I. et al. Clinical and metabolic features of urolithiasis and microlithiasis in children. Pediatr Nephrol 24, 2203–2209 (2009). https://doi.org/10.1007/s00467-009-1231-9

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  • DOI: https://doi.org/10.1007/s00467-009-1231-9

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