PURPOSE: Due to environmental and social changes, including obesity, as new risk factors for stone formation in adults, and changes in imaging techniques utilized, the aims of this study were to assess if changes in etiologies of primary pediatric urolithiasis have occurred and if relationships exist between it and obesity or imaging technique used.
MATERIALS AND METHODS: All pediatric patients with documented primary urolithiasis who had serum and 24-hour urine analyses between 1999-2010 were evaluated. Age at diagnosis, gender, BMI and imaging technique used were recorded.
RESULTS: There were 222 patients (48%M), all with normal serum creatinine, electrolytes and minerals; 73% diagnosed by ultrasound and 27% by CT. Annual incidence of urolithiasis per 1000 clinic visits increased from 2.4±1.5 in the first half of the study period to 6.2±2.1 in the second half (p< 0.005) Age at diagnosis was 11.8±3.8 and BMI 21.7±5.7; 15% being overweight. 140 patients had urine output < 1.0 ml/kg/h; in 54 as only abnormality. Hypercalciuria was observed in 46%, hypocitraturia in 10%, and 51% had high calcium/citrate ratio. Three patients had mild absorptive hyperoxaluria, 11 hyperuricosuria (all 14 had at least one additional abnormality); 1 had cystinuria. No etiology was identified in 20 (9.0%).
CONCLUSIONS: "Oliguria" and hypercalciuria continue to be the most common etiologies, followed by hypocitraturia. The recent increase in stone incidence is unlikely due to increased utilization of CT. Incidence of obesity was not higher than in the general population. Hyperoxaluria and cystinuria are rare; hence both may not be indicated in first analysis.
Written by:
Penido MG, Srivastava T, Alon US. Are you the author?
Pediatric Nephrology Unit, Clinics Hospital, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Reference: J Urol. 2012 Nov 27. pii: S0022-5347(12)05616-9.
doi: 10.1016/j.juro.2012.11.107
PubMed Abstract
PMID: 23201378
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