Clinical course and prognosis of patients with urolithiasis in a pediatric hospital
Main Article Content
Keywords
Urolithiasis, Child, Adolescent
Abstract
Background: Nephrolithiasis is considered rare in Pediatrics. Information available is not sufficient to establish its prognosis with certainty. The purpose of this research was to describe the signs, symptoms, complications and recurrence shown by pediatric patients with urolithiasis.
Methods: Medical records of pediatric patients with urolithiasis were identified for the period from 2003 to 2009.
Results: Sixty patients were included, out of which 26.2 % had some comorbidity and 31 % had a family history of lithiasis. The cardinal symptom was abdominal pain (65 %) and the most important sign was gross hematuria (46.6 %). 72.9% had some metabolic abnormality (predominantly hypercalciuria), 97.9% received medical and 70 % surgical treatment. Diet modification was the most widely used medical treatment (95.7 %). In 52 % initial treatment was surgical. During the follow-up, 18.7 % recurred and 12 % had renal failure.
Conclusions: The most common clinical conditions were abdominal pain, gross hematuria and dysuria. The most common metabolic cause was hypercalciuria, whereas the most common structural cause was ureteropielic stenosis. About 15 % recurred and 12 % were at risk of progression to kidney failure.
References
Gearhart JP, Herzberg GZ, Jeffs RD. Childhood urolithiasis: Experiences and advances. Pediatrics. 1991;87(4):445-6.
Parmar MS. Kidney stones. BMJ. 2004;328(7453): 1420-4. Disponible en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC421787/
Coward RJ, Peters CJ, Duffy PG, Corry D, Kellet MJ, Choong S, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child. 2003; 88(11):962-5. Disponible en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719348/
Yasui T, Iguchi M, Suzuki S, Kohri K. Prevalence and epidemiological characteristics of urolithiasis in Japan: Nation trends between 1965 and 2005. Urology. 2008;71(2):209-13.
Medina EM, Zaidi M, Real de León E, Orozco RS. Prevalencia y factores de riesgo en Yucatán, México, para litiasis urinaria. Salud Publica Mex. 2002;44(6):541-6. Disponible en http://bvs.insp.mx/rsp/ articulos/articulo.php?id=001544
Grases F, Costa-Bauza A, Prieto RM. Renal lithiasis and nutrition. Nutr J. 2006;5:23-32.
Moe OW, Bonny O. Genetic hypercalciuria. J Am Soc Nephrol. 2005;16(3):729-45.
Areses R. Enfermedad renal litiásica. Papel del pediatra en una patología del adulto. Bol S Vasco-Nav Pediatr. 2005;38(1):11-5.
Kollars J, Zarroug AE, van Heerden J, Lteif A, Stavlo P, Suárez L, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005;115(4):974-97.
Baldwin DN, Spencer JL, Jeffries-Stokes JCA. Carbohydrates intolerance and kidney stones in children in the Goldfields. J Paediatr Child Health. 2003;39(5):381-5.
Minevich E. Pediatric urolithiasis. Pediatric Clin North Am. 2001;48(6):1571-85.
Sakhaee K, Williams RH, Oh MS, Padalino P, Adams-Huet B, Whitson P, et al. Alkali absorption and citrate excretion in calcium nephrolithiasis. J Bone Miner Res. 1993;8(7):789-94.
Brennan S, Hering-Smith K, Hamm LL. Effect of pH on citrate reabsorption in the proximal convoluted tubule. Am J Physiol. 1988;255(2 Pt 2):F301-6.
Braun PM, Seif C, Jünemann KP, Alken P. Urolithiasis in children. Int Braz J Urol. 2002;28(6):539-44 Disponible en http://www.brazjurol.com.br/november_december_2002/Braun_ing_539_544.htm
Goodyer P, Saadi I, Ong P, Elkas G. Rozen R. Cystinuria subtype and risk of nephrolithiasis. Kidney Int. 1998;54(1):56-61. Disponible en http://www.nature.com/ki/journal/v54/n1/full/4490241a.html
Al-Rasheed S, Al Jurayyan NA, Al Nasser MN, Al-Mugeiren MM, Al-Salloum AA, Petterson BA. Nephrolithiasis in children and adolescents in the South Western Region of Saudi Arabia. Saudi J Kidney Dis Transpl. 1995;6(4):396-9.
Lagomarsino FE, Ávila SD, Baquedano DP, Cavagnaro SMF, Céspedes P. Litiasis urinaria en pediatría. Rev Chil Pediatr. 2003;74(4):381-8.
Medina-Escobedo M, Medina-Escobedo C, Martín-Soberanis G, Villanueva-Jorge S, Hernández-Flota A. Litiasis urinaria en lactantes: seguimiento a cuatro años. Rev Med Inst Mex Seguro Soc. 2008;46(6):195-200.
DeFoor W, Minevich E, Jackson E, Reedy P, Clark C, Sheldon C, et al. Urinary metabolic evalutions in solitary and recurrent stone forming children. J Urol. 2008; 179(6);2369-72.
Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115(10):2598-608.
Granberg FC, Krambeck EA, Gettman TM. Long-term follow-up of pediatric shockwave lithotripsy. J Urol. 2008;179(4):383.
Nelson E, Chacko J, Neheman A, Figueroa TE. Preoperative stenting in pediatric ureteroscopy. J Urol. 2008;179(4):383-4.
Mishra SK, Ganpule A, Manohar T, Desai MR. Surgical management of pediatric urolithiasis. Indian J Urol. 2007;23(4):428-34.
Diamond DA, Menon M, Lee PH, Rickwood AM, Johnston JH. Etiological factors in pediatric stone recurrence. J Urol. 1989;142(2 Pt 2):606-8.
Bush N, Brown B, Yucel S, Prieto J, Harrison C, Wilcox D, et al. Metabolic evaluation of pediatric patients with urolithiasis: 7 year single institution experience. J Urol. 2008;179(4):382-3.
Medina-Escobedo M, León-Burgos V, Duarte y Amándola A, Villanueva-Jorge S. Insuficiencia renal secundaria a litiasis en niños. Bol Med Hosp Infant Mex. 2006;63(6):395-401.
Bensalah K, Tuncel A, Gupta A, Raman JD, Pearle MS, Lotan Y. Determinants of quality of life for patients with kidney stones. J Urol. 2008;179(6):2238-43.
Kit LC, Filler D, Pike J, Leonard MP. Pediatric urolithiasis: Experience at a tertiary care pediatric hospital. Can Urol Assoc J. 2008;2(4):381-6. Disponible en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2532545/
Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc. 1993;68(3):241-8.
Arrabal-Martín M, Fernández-Rodríguez A, Arrabal-Polo MA, Ruiz-García MJ, Zuluaga-Gómez A. Estudio de factores físico-químicos en pacientes con litiasis renal. Arch Esp Urol. 2006;59(6):583-94.
Del Valle E, Spivacow R, Zanchetta JR. Alteraciones metabólicas en 2612 pacientes con litiasis renal. Medicina. 1999;59(5/1):417-22.
Tekin A, Tekqul S, Atsu N, Sahin A, Ozen H, Bakkaloglu M. A study of the etiology of idiopathic calcium urolithiasis in children: Hypocitruria is the most important risk factor. J Urol. 2002;164(1):162-5.