Influence of Overweight on 24-hour Urine Chemistry Studies and Recurrent Urolithiasis in Children
TL;DR: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL.
Abstract: Results: A total of 125 patients were included. The age of the patients in the NBW group was older than that of patients in the LBW group, but 24-hour urine chemistry studies did not differ significantly between the three groups. Mean urine citrate levels were lower (0.273±0.218 mg/mg/d vs. 0.429±0.299 mg/mg/d, p＜0.05) and the incidence of hypocitraturia was higher (81.5% vs. 45.7%, p＜0.05)) in the recurrent stone former group. In the univariate analysis, hypocitraturia and acidic urinary pH were risk factors, but in the multivariate analysis, only hypocitraturia was a risk factor for stone recurrence (hazard ratio, 3.647; 95% confidence interval, 1.047 to 12.703). In the Kaplan-Meier curve, the hypocitraturia group showed higher recurrence than did the normocitraturia group (p＜0.05). Conclusions: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL. Hypocitraturia was the only risk factor for UL in children.
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TL;DR: Overweight and obese stone forming children have decreased levels of urine citrate, phosphate and magnesium compared to patients with normal body mass index and the incidence of hypercalciuria is increased in overweight/obese patients.
19 citations
TL;DR: This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.
Abstract: Aim
There is conflicting evidence about the role of obesity in paediatric nephrolithiasis. This Polish study explored the influence of nutritional status and lipid disturbances on urinary lithogenic factors and the risk of kidney stone formation in children and adolescents from three to 18 years of age.
Methods
We carried out serum lipid profile evaluations and 24-h urine chemistry analyses on 493 overweight/obese paediatric participants (mean age 13 years) without nephrolithiasis and 492 healthy normal weight sex and age-matched controls.
Results
A third (33%) of the study group had blood lipid disturbances, with more acidic urine, lower urinary citrate excretion and a higher fraction of ionised calcium and higher Bonn Risk Index than the controls. The participants' body mass index standard deviation score (BMI Z-score) was positively correlated with urinary oxalate and uric acid and negatively correlated with citrate excretion. Total cholesterol, low-density lipoprotein cholesterol and triglycerides correlated negatively with citraturia, while high-density lipoprotein cholesterol correlated positively.
Conclusion
The main factor that predisposed overweight and obese children to kidney stones was hypocitraturia. Urinary citrate excretion was related to both BMI Z-scores and all lipid fraction abnormalities. However, hypercholesterolaemia and particularly low-density lipoprotein hypercholesterolaemia seemed to play a major role.
17 citations
TL;DR: This study confirmed the primary hypothesis that obese pediatric patients presenting with nephrolithiasis have a different urinary mineral profile as evidenced by lower levels of citrate and potassium and low urine pH; however, obese patients did not exhibit significantly elevated urinary sodium and uric acid when normalized to weight, as described in the adult population.
13 citations
TL;DR: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.
Abstract: PURPOSE To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department. MATERIALS AND METHODS We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups. RESULTS The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p<0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found. CONCLUSION LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.
6 citations
10 Sep 2019
TL;DR: In this article, the frecuencia de alteraciones urinarias presentes in ninos with urolitiasis segun estado nutricional was investigated.
Abstract: La urolitiasis es una enfermedad multifactorial. En los ultimos anos se ha observado un incremento a nivel mundial de la incidencia de la litiasis urinaria tanto en adultos como en ninos. Los cambios en los habitos alimentarios y un aumento en la prevalencia de exceso de peso podrian asociarse a este fenomeno. El objetivo del trabajo fue describir la frecuencia de alteraciones urinarias presentes en ninos con urolitiasis segun estado nutricional. En este trabajo observacional transversal se incluyeron 104 ninos litiasicos de ambos sexos divididos en dos grupos segun estado nutricional: 68 ninos con peso adecuado y 36 ninos con sobrepeso u obesidad considerando criterios de la OMS. Se determinaron en orina de 24 horas calcio, fosforo, sodio, acido urico, citrato y magnesio. Del total de pacientes participantes 54 (51.9%) fueron ninas y 50 (48,1%) fueron ninos. El 65,4% de los ninos presento peso normal y el 34,6% de los ninos sobrepeso u obesidad con edades medias de 10±4 anos y 8±4 anos respectivamente. El 80% de los ninos presento al menos una alteracion urinaria, siendo las mas frecuentes en ambos grupos la hipocitraturia e hiperuricosuria. Es llamativa la elevada frecuencia de alteraciones en las concentraciones de promotores e inhibidores de cristalizacion, en ambos grupos, indicando un riesgo aumentado de recidivas.
1 citations
Cites background from "Influence of Overweight on 24-hour ..."
...Estos resultados son similares a estudios en niños de Corea((19)), y con lo publicado en adultos a nivel nacional((20,21)), sin embargo, difieren con lo reportado por Bandari et al....
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...Estos resultados son similares a estudios en niños de Corea(19), y con lo publicado en adultos a nivel nacional(20,21), sin embargo, difieren con lo reportado por Bandari et al. en Estados Unidos en el 2016 quienes reportaron disminución del magnesio y citrato y aumento de la concentración del calcio urinario en el grupo de niños litiásicos con exceso de peso donde encontraron diferencia significativa en las concentraciones de los analitos urinarios(6)....
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References
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TL;DR: Upper percentile body weight was not associated with earlier stone development, larger stones or the need for multiple surgical procedures, but in lower percentileBody mass index patients symptomatic renal stones developed significantly earlier than in normal or upper percentile body Weight patients.
48 citations
"Influence of Overweight on 24-hour ..." refers methods in this paper
...[19] found no data to support a direct role for high BMI in the presentation or treatment of kidney stones by using 3 BMI categories according to the Centers for Disease Control and Prevention age-adjusted BMI percentiles for children, including LBW (10th percentile or less), NBW (10th to 85th percentile), and UBW (85th percentile or greater)....
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TL;DR: In this article, a retrospective cohort study was performed to assess urinary metabolic profiles in children with urolithiasis and found significant differences in the urinary calcium and citrate levels between children with solitary and recurrent calcium stone formation.
44 citations
TL;DR: High body mass was not associated with urolithiasis in a matched case-control study in a network of 30 primary care pediatric practices, however, black race and Medicaid payer status were associated with decreased odds of urology.
38 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...[20] reported that high body mass was not associated with UL in a matched...
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TL;DR: All children with nephrolithiasis should have a metabolic screen and children with a positive family history and consanguinity should be followed carefully with respect to metabolic abnormalities.
Abstract: Objective
The aim of this study is to evaluate the clinical outcome in children with urinary calculi, to detect risk factors for nephrolithiasis in childhood.
35 citations
"Influence of Overweight on 24-hour ..." refers background in this paper
...[23] reported the incidence of idiopathic hypercalciuria as the most common factor in 40% of cases....
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TL;DR: It is suggested that MS is significantly associated with increased risk of developing urine acidification, even with changes in status of MS observed during follow-up.
22 citations