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Journal ArticleDOI

Urolithiasis in pediatric patients.

01 Mar 1993-Vol. 68, Iss: 3, pp 241-248
TL;DR: Overall, 166 of 221 children examined at the Mayo Clinic between 1965 and 1987 were found to have factors that predisposed to urolithiasis, and 166 of 166 children (75.1%) were foundTo determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithsiasis encountered in a referral center, retrospectively assessed 221 patients.
Abstract: Urolithiasis in pediatric patients has been perceived as uncommon, and the appropriate evaluation and management have been controversial. To determine the clinical characteristics, types of stone problems, and outcomes of pediatric patients with urolithiasis encountered in a referral center, we retrospectively assessed 221 patients (113 girls and 108 boys) with urolithiasis examined at the Mayo Clinic between 1965 and 1987. The median age at onset of symptoms was 11 6 / 12 years among the female patients and 10 6 / 12 years among the male patients. Analysis of stone constituents in 122 patients showed the proportion of calcium oxalate (44.7%), calcium phosphate (23.6%), and cystine (8.1%) stones to be similar in all age-groups. Overall, struvite stones were found in 17.1% and uric acid stones in 1.6% of patients. Conditions that predisposed to metabolic urolithiasis were identified in 115 patients (52%). Hypercalciuria was confirmed in 49 of 145 patients (33.8%) and hyperoxaluria in 25 of 124 (20.2%). Eight of 96 patients had hyperuricosuria, and 5 of 54 had hypocitraturia. Forty-one patients (18.6%) had infection-related stones. Of 66 patients with structural anomalies of the genitourinary tract, 24 (36%) had metabolic abnormalities and 26 (39%) had chronic infection. Among patients with chronic infection, 29% had metabolic abnormalities. Of the 221 patients, 148 (67%) had two or more stones during a mean follow-up of 59 months. Among 140 patients with 12 months or more of follow-up, metabolic activity was present in 31 (22.1%) at the time of most recent examination. Overall, 166 of 221 children (75.1%) were found to have factors that predisposed to urolithiasis. Infected, obstructed, or structurally anomalous urinary tracts seem to be factors permissive for formation of stones and do not obviate the need for careful metabolic assessment in all young patients who form renal stones.
Citations
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Journal ArticleDOI
TL;DR: Recommendations are given for the management of patients with acute stone colic and for active removal of stones from the ureter and kidney and the principles for risk evaluation of Patients with recurrent stone formation and appropriate recurrence preventive treatment are given.

1,169 citations

Journal ArticleDOI
TL;DR: Significant differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis.
Abstract: Archeological findings give profound evidence that humans have suffered from kidney and bladder stones for centuries. Bladder stones were more prevalent during older ages, but kidney stones became more prevalent during the past 100 years, at least in the more developed countries. Also, treatment options and conservative measures, as well as ‘surgical’ interventions have also been known for a long time. Our current preventive measures are definitively comparable to those of our predecessors. Stone removal, first lithotomy for bladder stones, followed by transurethral methods, was definitively painful and had severe side effects. Then, as now, the incidence of urolithiasis in a given population was dependent on the geographic area, racial distribution, socio-economic status and dietary habits. Changes in the latter factors during the past decades have affected the incidence and also the site and chemical composition of calculi, with calcium oxalate stones being now the most prevalent. Major differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations. Extensive epidemiological observations have emphasized the importance of nutritional factors in the pathogenesis of urolithiasis, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis.

354 citations


Cites background from "Urolithiasis in pediatric patients...."

  • ...In the USA, nephrolithiasis is said to be responsible for 1 in 7,600 to 1 in 1,000 pediatric hospital admissions [25, 55]....

    [...]

Journal ArticleDOI
TL;DR: There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years, with underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection.
Abstract: Background: The previous epidemiological study of paediatric nephrolithiasis in Britain was conducted more than 30 years ago. Aims: To examine the presenting features, predisposing factors, and treatment strategies used in paediatric stones presenting to a British centre over the past five years. Methods: A total of 121 children presented with a urinary tract renal stone, to one adult and one paediatric centre, over a five year period (1997–2001). All children were reviewed in a dedicated stone clinic and had a full infective and metabolic stone investigative work up. Treatment was assessed by retrospective hospital note review. Results: A metabolic abnormality was found in 44% of children, 30% were classified as infective, and 26% idiopathic. Bilateral stones on presentation occurred in 26% of the metabolic group compared to 12% in the infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting urinary tract infection was common (49%) in the metabolic group. Surgically, minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and endoscopy) were used in 68% of patients. Conclusions: There has been a shift in the epidemiology of paediatric renal stone disease in the UK over the past 30 years. Underlying metabolic causes are now the most common but can be masked by coexisting urinary tract infection. Treatment has progressed, especially surgically, with sophisticated minimally invasive techniques now employed. All children with renal stones should have a metabolic screen.

224 citations

Journal ArticleDOI
TL;DR: The epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH are reviewed, with an emphasis on childhood manifestations.
Abstract: Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH, with an emphasis on childhood manifestations.

201 citations


Cites background from "Urolithiasis in pediatric patients...."

  • ...It is said to account for about 1 % of all kidney stones and up to 25 % of pediatric stones [24]....

    [...]

Journal ArticleDOI
TL;DR: Younger patients with primary urinary lithiasis are more likely to present with renal calculi and less likely to pass these stones, probably due to the relatively larger stone burden and location, and should be followed aggressively.

186 citations

References
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Book
01 Jan 1963

831 citations

Journal ArticleDOI
TL;DR: The first description of the incidence and recurrence rates for symptomatic noninfected renal stones in a well-defined population of Rochester, Minnesota, between 1950 and the end of 1974 is described.

486 citations

Journal ArticleDOI
TL;DR: Of the 28 patients with primary hyperparathyroidism (resorptive hypercalciuria), 25 had hypercalcemia and 21 had high fasting urinary calcium, and six patients with renal hyperCalciuria had normocalcemia, high fasting kidneys, and high-normal fasting urinary cyclic AMP was normal.
Abstract: A test was developed to diagnose various forms of hypercalciuria. A two-hour urine sample after an overnight fast and a four-hour urine sample after 1 g of calcium by mouth were tested for calcium, cyclic AMP and creatinine. The 24 patients with absorptive hypercalciuria had normocalcemia and normal fasting urinary calcium (less than 0.11 mg per milligram of urinary creatnine). Urinary calcium was high (greater than or equal to 0.2 mg per milligram of creatinine) after a calcium load. Of the 28 patients with primary hyperparathyroidism (resorptive hypercalciuria), 25 had hypercalcemia and 21 had high fasting urinary calcium. Urinary cyclic AMP, elevated in 30 per cent of fasting patients, was high (greater than 4.60 mu moles per gram of creatinine) in 82 per cent of cases after calcium load. Six patients with renal hypercalciuria had normocalcemia, high fasting urinary calcium, and high (greater than 6.86 mu moles per gram of creatinine) or high-normal fasting urinary cyclic AMP was normal. This simple test should facilitate the differentiation of various causes of hypercalciuria.

463 citations

Journal ArticleDOI
TL;DR: The 24-hour urine calcium excretion could be predicted with reasonable confidence from the calcium/creatinine concentration ratio of the second urine specimen passed in the morning and after a milk load of 700 ml/1·73 m2, but in no sample exceeded 0·25 mg/mg.
Abstract: Urine calcium excretion in healthy children was 2·38±0·66 (SD; no. = 52) mg/kg per 24 hr and urinary magnesium excretion was 2·82±0·79 (SD; no. = 23). The 24-hour urine calcium excretion could be predicted with reasonable confidence from the calcium/creatinine concentration ratio of the second urine specimen passed in the morning. In this specimen the urine calcium/creatinine concentration ratio was 0·14±0·06 (SD; no. = 60) mg/mg and the magnesium/creatinine concentration ratio was 0·21±0·10 (SD; no. = 29) mg/mg. The upper limit of the urine calcium excretion is taken to be 4 mg/kg per 24 hr and that of the calcium/creatinine concentration ratio in the second morning urine is 0·25 mg/mg. After a milk load of 700 ml/1·73 m 2 the urinary calcium/creatinine concentration ratio rose in the first two hours, but in no sample exceeded 0·25 mg/mg.

258 citations

Journal ArticleDOI
TL;DR: The solubility of calcium monohydrogen phosphate appears to determine the precipitation of calcium phosphates from aqueous solutions; this salt then undergoes transformation to apatites, which are the principal cation in human beings.
Abstract: CALCIUM is the most abundant cation in human beings. The total body content averages about 25,000 mmol, or 1 kg, in a 70-kg man — virtually all of it occurring in bone.1 Perhaps the most important biochemical property of calcium is that it forms salts that are barely soluble (Fig. 1).2 The solubility of calcium monohydrogen phosphate (CaHPO4·2H20) appears to determine the precipitation of calcium phosphates from aqueous solutions; this salt then undergoes transformation to apatites [Ca10(PO4)6(OH)2 or Ca10(PO4)6CO3], which are the principal . . .

254 citations