Evaluation of children with urolithiasis
Objectives: To describe an evaluation protocol for pediatric stone formers for risk assessment and management strategies. Materials and Methods: Between 2002-2006, 2618 children of age three months to 15 years were evaluated for stone disease. Evaluation included demographics, history, anthropometr...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2007-01-01
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| Series: | Indian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.indianjurol.com/article.asp?issn=0970-1591;year=2007;volume=23;issue=4;spage=420;epage=427;aulast=Rizvi |
| Summary: | Objectives: To describe an evaluation protocol for pediatric stone formers for risk assessment and management strategies.
Materials and Methods: Between 2002-2006, 2618 children of age three months to 15 years were evaluated for stone disease. Evaluation included demographics, history, anthropometry, diet, ultrasound, X-ray KUB, IVU, blood and 24h urine chemistry and cultures. Stones were analyzed by IR spectroscopy.
Results: The median age was seven years with a M:F ratio of 2.2:1. Of the 2618 patients, 2216 presented with normal renal function and 402 with renal failure. Main symptoms were abdominal pain (33%), flank pain (38%) and fever (38%). Renal failure patients also had shortness of breath (38%) and oligo-anuria (26%). Children were malnourished with height and weight deficits in 65% and 76% respectively. Diet was low in protein (74%), calcium (55%) and fluids in (55%), high in oxalate (55%), sodium (39%), purines (42%) and refined sugar (41%). Overall urine cultures were positive in 1208 (46%) with E. coli (38%) and Klebsiella (8%).
Stone distribution was renal in 64%, ureter in 8%, bladder in 18%, bilateral in 40% and multiple sites in 18%. Median stone size was> 1.5-2.0 cm. The frequency of compounds in stones was ammonium urate (58%), calcium oxalate (63%), uric acid (6%), calcium phosphate (12%) and struvite (8%). Metabolic abnormalities included hypovolumia (31%), hypocitraturia (87%), hyperoxaluria (43%) and hyperuricosuria (26%). Dietary and medical treatment corrected risk factors in two-thirds of patients with a recurrence rate of about 1.15%.
Conclusion: An evaluation based on history, imaging, diet, metabolic analysis and stone type can help to tailor management strategies. |
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| ISSN: | 0970-1591 1998-3824 |