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Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo MV, Kamal W, Ibrahim TAA, Cho A, Mazzon G, Chai CA, Ferretti S, Zhong W, Onal B, Mohamed O, Saulat S, Jurkiewicz B, Sezer A, Liu Y, Zeng T, Wang W, Gauhar V, Elderwy AA, Zaidi Z, Duvdevani M, Hamri SB, Kumar N, Kartalas-Goumas L, Gadzhiev N, Kraft K, Sepulveda F, Halinski A, Marietti S, Al-Anazi NAS, Santos LS, Vaddi CM, Jia J, Li J, Kuang X, Ye Z, Sarica K. International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis. Urolithiasis 2024; 52:124. [PMID: 39230669 DOI: 10.1007/s00240-024-01621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024]
Abstract
The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Wei Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | | | - Wissam Kamal
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | | | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, UK
| | - Chu Ann Chai
- Department of Surgery Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Stefania Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bulent Onal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Omar Mohamed
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Sherjeel Saulat
- Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
| | - Beata Jurkiewicz
- Paediatric Surgery Department, Warsaw Hospital for Children, Warsaw, Poland
| | - Ali Sezer
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - Yang Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Wang
- Department of Urology, Shanghai Public Health Clinical Center, Center of GRADE, Fudan University, Shanghai, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, The National University Health System, Singapore, 609606, Singapore
| | - Ahmad Abdelaziz Elderwy
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Zafar Zaidi
- The Indus Hospital and Health Network, Karachi, Pakistan
| | | | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nitesh Kumar
- Ford Hospital and Research Centre, Patna, 800027, India
| | | | - Nariman Gadzhiev
- Saint Petersburg State University Hospital, St. Petersburg, Russian Federation
| | - Kate Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Fabio Sepulveda
- Department of Urology, Federal University of Bahia, State Women's Hospital of Bahia, Salvador, Bahia, Brazil
| | - Adam Halinski
- Department of Paediatric Urology, PMC "Wisniowa Clinic", Zielona Gora, Poland
| | - Sarah Marietti
- University of California - San Diego, 200 West Arbor Drive MC 7897, San Diego, CA, 92103, USA
| | | | - Luiz Sergio Santos
- Department of Urology, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Chandra Mohan Vaddi
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Lane, Mig1, Kphb Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Jianye Jia
- Department of Urology, Peking University International Hospital, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaogen Kuang
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey.
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Chen S, Zhang T, Zhang J, Ma X, Wu P, Liu S, Lan X, Gao H. Current Status and Prospects of Pediatric Stone Disease: A Bibliometric and Visualization Study. Cureus 2024; 16:e56549. [PMID: 38646203 PMCID: PMC11027950 DOI: 10.7759/cureus.56549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Pediatric stone disease, once considered rare, has emerged as a significant research area in the past two decades due to a sharp increase in its incidence. Understanding the evolving epidemiology and treatment strategies for pediatric stone disease is crucial for enhancing child health protection. This study aims to summarize the advancements in pediatric stone disease research over the last two decades through bibliometric analysis. We conducted a comprehensive search in the Web of Science Core Collection (WoSCC) for literature on pediatric stone disease from January 1, 2000 to February 20, 2024. Econometric analyses were performed using tools such as VOSviewer, CiteSpace, and the R package "bibliometrix." Our search yielded 1,208 publications, predominantly from the United States and Turkey, showing an annual increase in publications on pediatric stone disease. Leading research institutions include Dicle University, Children's Hospital of Philadelphia, and the University of Pennsylvania, with the Journal of Pediatric Urology publishing the highest number of articles. The most prolific authors were C.P. Nelson and B. Hoppe, with Caleb P. Nelson being the most co-cited author. Research themes primarily focused on risk factors and therapeutic approaches for pediatric stone disease. Emerging research hotspots are identified by keywords such as mechanism, mini-percutaneous nephrolithotomy, recurrence, and retrograde intrarenal surgery. The study forecasts a continued upward trend in global research on pediatric stone disease, with future studies likely to delve deeper into risk factors and novel therapeutic methods.
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Affiliation(s)
- Sheng Chen
- Medicine, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Ting Zhang
- Integrative/Complementary Medicine, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Jianqiang Zhang
- Urology, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Xiaohan Ma
- Medicine, Guangxi University of Chinese Medicine, Nanning, CHN
| | - PeiZhong Wu
- Medicine, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Shaoning Liu
- Medicine, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Xuan Lan
- Medicine, Guangxi University of Chinese Medicine, Nanning, CHN
| | - Hongjun Gao
- Urology, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, CHN
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Öner N, Baştuğ F, Özkan B, Özçatal M, Karakükçü Ç. Urolithiasis in children; The importance of stone localization in treatment and follow-up. Urolithiasis 2024; 52:17. [PMID: 38165472 DOI: 10.1007/s00240-023-01518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
To evaluate the demographic, etiologic, treatment, and follow-up differences in stones according to their location within the kidney. This retrospective study comprised 337 patients with urolithiasis between 2015 and 2019. Patients were classified into 2 groups according to stone location as lower pole stones (LPS) and upper-middle pole stones (UMPS). The patient's data were recorded at 3-month intervals for one year. One hundred and eighty-three (54.3%) female and 154 (45.7%) men were included in the study. One hundred and twenty-nine (38.3%) of the stones were in the LPS and 208 (61.7%) in the UMPS. UMPS was more common in patients aged > 12 months (p < 0.01). At least one metabolic risk factor was present in 93 (72.1%) patients with LPS and 164 (78.4%) with UMPS. The most common urinary metabolic risk factors were hyperoxaluria (31.8%) in patients with LPS and hypocitraturia (34.1%) in patients with UMPS. ROC analysis results showed that cut-off values of 5.5 mm for LPS and 6.1 mm for UMPS did not provide improve with medical treatment. At the 6- and 12-month follow-ups, the improvement rates were higher in the UMPS group than in the LPS group (p < 0.05). During the follow-up, recurrence was detected in 43 patients: 29% of patients with LPS and 5.8% of patients with UMPS (p < 0.01). Patients with small stones can be followed up. Surgical treatment may be considered for small stones in the LPS. In addition, the risk of recurrence is higher in patients with LPS, and close follow-up is required.
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Affiliation(s)
- Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Bilkent City Hospital, 06800, Bilkent, Cankaya/Ankara, Turkey.
| | - Funda Baştuğ
- Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Büşra Özkan
- Department of Pediatrics, Beylikduzu State Hospital, Istanbul, Turkey
| | - Mustafa Özçatal
- Department of Pediatric Surgery, Adana Seyhan State Hospital, Adana, Turkey
| | - Çiğdem Karakükçü
- Division of Medical Biochemistry, University of Erciyes, Kayseri, Turkey
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Klib M, Ghandour M, Wannous H. Urinary stone disease in Syrian children. Pediatr Nephrol 2023; 38:2699-2709. [PMID: 36662300 DOI: 10.1007/s00467-022-05860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pediatric urinary stone disease (USD) is a costly medical problem. This study aims to assess the clinical characteristics and outcomes of common and rare causes of pediatric USD. METHODS A retrospective descriptive cohort study included all children < 13 years of age with confirmed USD admitted to the Children's University Hospital in Damascus, Syria, from January 2013 to December 2019. The study sample was divided into two groups based on etiologies: common and rare causes groups. RESULTS We evaluated 235 patients; 147 of them were males, and the male-to-female ratio was 1.7:1. The common causes group consisted of 203 patients (mean age 3.52 ± 3.66 years) and mainly included metabolic disorders (45.5%) and anatomical abnormalities (22.3%), while the rare causes group included 32 cases (mean age 4.93 ± 4.08 years), 12 patients with uric acid stones (37.5%), 7 patients with cystinuria (21.9%), and primary hyperoxaluria in 5 patients (15.6%). In addition, 39.6% of study patients were born to consanguineous marriages. Sixty-two patients developed AKI, and eleven patients had chronic kidney disease (CKD). Patients with rare causes were more likely to have AKI, CKD, bilateral stones, and recurrent stones (P-value < 0.05). Stone analysis was performed on 83 patients, and the main stone types were calcium oxalate (34.9%), uric acid (14.4%), and struvite stones (12%). Surgery was the most performed treatment in 101 patients (56.7%). CONCLUSION Patients with rare causes of pediatric USD are at a higher risk for severe complications and require early diagnosis and management. The high rate of uric acid stones in our society requires further evaluation for possible underlying causes. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mohamad Klib
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Munir Ghandour
- Department of Internal Medicine, Al-Mouwasat University Hospital, Damascus University, Damascus, Syria
| | - Hala Wannous
- Department of Pediatric Nephrology, Children's University Hospital, Damascus University, Damascus, Syria
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Isik G, Bozdag PG. Why is childhood urolithiasis increasing? Etiology, diagnosis and management: a single-center experience. J Nephrol 2023:10.1007/s40620-023-01638-4. [PMID: 37160650 DOI: 10.1007/s40620-023-01638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Globally, urolithiasis is becoming more and more common among children. We aimed to determine the etiology, and the diagnostic and therapeutic approaches in patients with urolithiasis. METHODS This was a retrospective study which included all patients (aged 1 month-18 years) admitted to the pediatric nephrology clinic in Elazığ Fethi Sekin City Hospital with urolithiasis between November 2019 and 2021. Only patients whose diagnosis of urolithiasis was confirmed by urinary ultrasonography were included in the study, while patients with chronic diseases (neurological diseases such as epilepsy, cerebral palsy, chronic bowel diseases, etc.) predisposing to kidney stone formation were not. Demographic characteristics, serum and urine biochemical parameters, urine metabolic and kidney stone metabolic and chemical analyses, urinary tract ultrasonography findings and treatment modalities were collected. RESULTS One hundred ninety-seven patients (91 female and 106 male) were included in the study. Hypervitaminosis D was detected in 4 (2%) patients, suppressed parathyroid hormone in 12 (6%) and hypercalcemia in 27 (14%) patients. Metabolic screening showed hypercalciuria in 69 (35%) patients, hypocitraturia in 39 (20%), hyperoxaluria in 15 (8%) and cystinuria in 6 (3%) patients. Eighty three (42%) patients had a positive family history for kidney stones. One hundred eighteen (60%) patients received potassium citrate treatment, 71 (36%) were given hydration and diet recommendations without medical treatment, 6 (3%) received tiopronin treatment, and 2 (1%) patients were treated surgically. CONCLUSIONS Our study suggests that Vitamin D supplementation at doses higher than 400 IU/day may be a risk factor for kidney stones in children. We observed that mothers tend not to give water to infants who are breastfed or formula-fed in the first year of life. K-citrate treatment can be a good option for prevention and dissolution of stones by alkalinization.
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Affiliation(s)
- Gunes Isik
- Pediatric Nephrology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey.
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Bernardor J, Bidault V, Bacchetta J, Cabet S. Pediatric urolithiasis: what can pediatricians expect from radiologists? Pediatr Radiol 2023; 53:695-705. [PMID: 36329164 DOI: 10.1007/s00247-022-05541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
The incidence of urolithiasis in children has increased over the two last decades. Urolithiasis formation results from urine oversaturation following insufficient water intake, urinary obstruction (notably in cases of congenital uropathies), excess production of an insoluble compound, or imbalance between crystallization promoters and inhibitors. Whereas most urolithiases in adults occur secondary to environmental factors, in children, secondary causes are far more frequent, and 15% are related to genetic causes, most often monogenic. This is especially true in recurrent forms, with early and rapid progression and bilateral stones, and in cases of familial history or consanguinity. Because of differing clinical management, one should rule out cystinuria, primary hyperoxaluria and renal tubular acidosis, among other causes of urolithiasis. As such, a complete biochemical evaluation must be performed in all cases of pediatric urolithiasis, even in cases of an underlying uropathy. Ultrasound examination is the first-line modality for imaging pediatric urolithiasis, allowing both diagnosis (urolithiasis and its complications) and follow-up. US examination should also explore clues to an underlying cause of urolithiasis. This review is focused on the role of imaging in the management and etiological assessment of pediatric urolithiasis. Radiologists play an important role in pediatric urolithiasis, facilitating diagnosis, follow-up and surgical management. A trio of clinicians (pediatric nephrologist, pediatric surgeon, pediatric radiologist) is thus necessary in the care of these pediatric patients.
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Affiliation(s)
- Julie Bernardor
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
- Institut National de la Santé et de la Recherche Médicale, Lyon, France.
- Service de Néphrologie Pédiatrique, Centre Hospitalo-Universitaire de Nice, Hôpital Archet, Nice, France.
- Faculté de Médecine, Université Côte d'Azur, Nice, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Institut National de la Santé et de la Recherche Médicale, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Sara Cabet
- Service d'imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Physiopathologie et Génétique du Neurone et du Muscle, Institut NeuroMyoGène, Université de Lyon, Lyon, France
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Castellani D, Giulioni C, De Stefano V, Brocca C, Fuligni D, Galosi AB, Teoh JYC, Sarica K, Gauhar V. Dietary management of hypocitraturia in children with urolithiasis: results from a systematic review. World J Urol 2023; 41:1243-1250. [PMID: 36645461 DOI: 10.1007/s00345-023-04282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Hypocitraturia is a low urinary excretion of citrate and a well-known risk factor for kidney stone development in children. This systematic review aimed to evaluate the dietary management of hypocitraturia in children with urolithiasis. METHODS Literature search was performed on 30th September 2022 using Embase, PubMed, and Cochrane Central Controlled Register of Trials. Studies were included if children with stones and hypocitraturia were managed with diet supplements. RESULTS Six papers were included. Four studies evaluated the role of oral potassium citrate associated with high fluid intake on stone resolution and recurrence. Two studies assessed the impact of oral potassium citrate on long-term stone recurrence after percutaneous nephrolithotomy and shock wave lithotripsy. All studies demonstrated that the association of potassium citrate and high fluid intake was well tolerated with no side effects and restored normal urine citrate excretion, allowed a reduction in stone size, and, following definitive treatments, was associated with a lower rate of stone regrowth and recurrence compared with controls. These effects were demonstrated across all pediatric ages. CONCLUSIONS Our review infers that oral potassium citrate and high fluid assumption are safe and effective in restoring urine citrate excretion, treating and preventing stone recurrence with no serious adverse events, and should probably be the first-line treatment of pediatric patients with asymptomatic stones and hypocitraturia.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy. .,Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy.
| | - Carlo Giulioni
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, 60126, Ancona, Italy.,Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H.Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Diet, Fluid Intake, Urine Output and Urinary Sodium/Potassium Ratios in Children With Urolithiasis. Indian Pediatr 2022. [PMID: 35959759 PMCID: PMC9518939 DOI: 10.1007/s13312-022-2603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a cross-sectional study on 25 children (17 boys) with urolithiasis with normal glomerular functions at a tertiary care teaching hospital between March, 2018 to March, 2019. Dietary assessment showed that caloric intake was below recommended dietary allowance (RDA) in 68% patients while the median protein intake was 34.3% more. The fluid intake was below the recommended standards in 56%, and 48% of the children had urine output below 1.5 mL/kg/hour. The urinary sodium was elevated in 96% of the children, urinary potassium was low in 40%, and hypercalciuria was seen in 28%. While metabolic causes predominate in childhood urolithiasis, other factors like dietary changes, liberal fluid and low sodium intake are advised for prevention of recurrences as they have a contributory role too.
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Mu XN, Guo LF, Wang PX, Zhang LY, Wang SJ. Semirigid Ureteroscopy Therapy against Childhood Kidney Stones. Appl Bionics Biomech 2022; 2022:7771920. [PMID: 35979239 PMCID: PMC9377984 DOI: 10.1155/2022/7771920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of the current study was to assess the effectiveness of semirigid ureterorenoscopy (URS) as first-line therapy for early childhood patients with <20 mm stones in the pelvic, middle, or upper calices. Methods In all, 61 pediatric kidney stone patients who had flexible ureteroscopy (fURS) between January 1, 2010, and December 31, 2019, were included in this study. Before fURS, semirigid URS employed the UreTron or holmium: YAG (Ho : YAG) laser was conducted. When semirigid URS was unsuccessful, fURS was used for retrograde intrarenal surgery (RIRS). All participants were monitored clinically for a minimum of three months after each procedure. Results The patient's mean age was 4.52 ± 1.53 years, and 52 (83.61%) participants underwent semirigid URS successfully. Mean procedural duration of semirigid URS was 36.49 ± 7.72 min. The stone-free rate after semirigid URS was 92.16% (47/51). During the postprocedural medical observation, there were no serious adverse effects. Conclusions Based on the present study's findings, semirigid URS is a low-risk, effective therapy for kidney stones in selected pediatric patients.
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Affiliation(s)
- Xiao-Nan Mu
- Cadres Integrative Unit 2, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Long-Fei Guo
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Peng-Xin Wang
- College of Basic Medicine, Jining Medical University, Jining, 272067 Shandong, China
| | - Long-Yang Zhang
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
| | - Si-Jun Wang
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013 Shandong, China
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Paraboschi I, Gnech M, De Marco EA, Minoli DG, Bebi C, Zanetti SP, Manzoni G, Montanari E, Berrettini A. Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives. Front Pediatr 2022; 10:886425. [PMID: 35757114 PMCID: PMC9218273 DOI: 10.3389/fped.2022.886425] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gnech
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Adalgisa De Marco
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Guido Minoli
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianantonio Manzoni
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alfredo Berrettini
- Pediatric Urology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Comparison of infants and children with urolithiasis: a large case series. Urolithiasis 2022; 50:411-421. [PMID: 35482085 DOI: 10.1007/s00240-022-01327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 ± 35 months (0.4-231 months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3 mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12 months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF ( - ) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease.
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SÜRMELİ DÖVEN S, DANACI VATANSEVER E, İSBİR C, NAYCI A, DELİBAŞ A. Pediatric urinary stone disease: experience from a Turkish tertiary referral center. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.994606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Çaltik Yilmaz A, Ünal N, Çelebi Tayfur A, Büyükkaragöz B. How important urolithiasis is under 2 years of age? Urolithiasis 2021; 50:159-165. [PMID: 34842953 DOI: 10.1007/s00240-021-01295-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
Urolithiasis (UL) is a common health problem in the world and the observed incidence of this disease is increasing in the infantile period. The study included cases of UL diagnosed before the age of two who had a comprehensive analysis for possible etiologic variables and were followed for a minimum of 6 months. Of the 60 patients included in the study, 37 were male, and the male/female ratio was 1.6. The average age at diagnosis is 8.5 ± 4.5 months. Of the cases diagnosed 41 (68.3%) were before than 1 year of age. The average time for follow-up is 28.9 ± 22.6 months. There was a family history of stone disease in 41 (68.3%) cases. Twenty-four (40%) patients were treated for dehydration at least once before stone disease was identified. The number of patients presenting with symptoms is 43 (71.7%). Restlessness was noted as the main symptom. In 17 (28.3%) patients, stone disease was found incidentally. Metabolic causes (n: 19, 31.6%) were determined to be the most common underlying cause, followed by UTI-related causes (n: 12, 20%). During the follow-up, 57 (64%) of the stones spontaneously disappeared. The size of 16 (18%) stones reduced, while the size of eleven remained same (13%). Following their absence, nine (15%) of the stones reappeared. The essential strategy is to identify high-risk groups, to closely monitor them, and to take preventative interventions against modifiable conditions such as dehydration if possible.
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Affiliation(s)
| | - Necla Ünal
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Aslı Çelebi Tayfur
- Department of Pediatric Nephrology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Ankara Gazi University, Ankara, Turkey
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RENDA R. Sıcak iklim değişiklikleri çocuklarda nefrolitiazis riskini arttırır mı? EGE TIP DERGISI 2021. [DOI: 10.19161/etd.990179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Fang AM, Gibson E, Oster RA, Dangle PP. Effect of age, BMI, and gender on urinary risk factors in pediatric idiopathic stone formers. J Pediatr Urol 2021; 17:477.e1-477.e9. [PMID: 34217589 PMCID: PMC8812992 DOI: 10.1016/j.jpurol.2021.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The incidence of pediatric urolithiasis has been increasing over the years; however, the etiology of this increase is not well understood. Age, body mass index, and gender have been examined as possible risk factors for stone disease, but with inconsistent and variable associations. OBJECTIVE We aim to investigate the urine chemistry factors, as assessed by 24-h urinary parameters, in pediatric stone formers at a large volume tertiary referral center in the highest areas in the United States, the Southeast, based on age, body mass index, and gender. STUDY DESIGN We retrospectively reviewed all pediatric stone formers who completed a 24-h study between 2005 and 2016. Patients were stratified by age (3-10 versus 11-18 years of age), overweight status (above versus below the 85th percentile for body mass index), and gender (male versus female) (Summary Figure). Statistical analysis included analysis of variance and logistic regression. RESULTS 243 patients were included in our analysis. Patients in the first decade of life were found to have greater numbers of urinary risk factors than those in the second decade. Non-overweight patients were more likely to have hyperoxaluria and hyperuricosuria, while overweight patients were more likely to have hypocitraturia. Female patients were more likely to have higher hyperoxaluria, while male patients were more likely to have hypercalciuria. DISCUSSION In contrast to prior publications, obesity is not linked to increased risk of urolithiasis with non-overweight individuals having a greater number of risk factors than the overweight cohort. Despite stone disease being more prevalent in adolescents, the greatest number of risk factors were present in the first decade of life. Lastly, female children had more urinary risk factors than males. Further understanding of the underlying causes of stone disease in various pediatric populations is warranted. CONCLUSION While more urinary risk factors were identified in younger, non-overweight, and female patients, there remains no consensus on the urinary risk factors for pediatric urolithiasis. Further study is needed to elucidate the risk factors and pathophysiology of pediatric stone disease.
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Affiliation(s)
| | - Elena Gibson
- University of Alabama at Birmingham, AL, USA; University of Utah, UT, USA
| | | | - Pankaj P Dangle
- University of Alabama at Birmingham, AL, USA; Children's of Alabama, Birmingham, AL, USA.
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16
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Is medical treatment necessary for infants with small urinary stones? Urolithiasis 2021; 49:457-462. [PMID: 33555388 DOI: 10.1007/s00240-021-01248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Urinary stone disease is a common condition. We investigated the usefulness of medical treatment for infants with urinary stones 5 mm or smaller. The study included 197 infants (86 girls and 111 boys) with urolithiasis ≤ 5 mm who were referred to our Department of Nephrology between 2014 and 2016. Infants with metabolic or anatomical risk factors requiring medical treatment were excluded from the study. We retrospectively reviewed urine and serum metabolic profiles and compared stone resolution rates in patients who did and did not receive treatment. The mean age at diagnosis was 5.2 months (range, 14 days to 12 months). The most common complaint was restlessness (n = 92, 46.7%), and 49 infants (24.9%) were asymptomatic. Multiple stones were detected in 166 infants (84.3%). Hypomagnesuria, hypocitraturia, and hypercalciuria were present in 25.3, 19.7, and 18.7% of patients, respectively. Stones < 3 mm (microlithiasis) were detected in 97 infants (49.2%), and 100 (50.8%) patients had 3-5 mm stones. In total, 130 infants (66.5%) received regular treatment and 67 (33.5%) were not treated. Stone resolution was significantly higher in the group receiving K-citrate treatment at the 6th month follow-up, while there were no significantly difference between the two groups at the 12th month control. No previous studies have investigated treatment outcomes in infants with 3-5 mm urinary stones. According to our results, K-citrate treatment may accelerate the resolution of the stone in infants with stones smaller than 5 mm.
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Önal B, Kırlı EA. Pediatric stone disease: Current management and future concepts. Turk Arch Pediatr 2021; 56:99-107. [PMID: 34286317 DOI: 10.5152/turkarchpediatr.2021.20273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 12/30/2022]
Abstract
Treatment of pediatric urolithiasis consists of medical and surgical approaches. The main goal of the treatment is to prevent stone recurrence by avoiding multiple surgical interventions. In recent years, many innovations have been reported in the medical diagnostic evaluation protocol and in surgical treatment. According to recent reports, single mutations could be responsible for a larger proportion of renal stones. This etiologic feature holds the potential to change the management in stone prevention from metabolically directed therapy to more specific approaches. In addition, miniaturized instruments have been adopted in clinical practice. In recent years, minimally invasive endoscopic surgery is the treatment of choice in pediatric urolithiasis. This review aims to assess the current literature on medical and surgical treatment options for pediatric urolithiasis. We also aim to provide an overview of potential future advances.
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Affiliation(s)
- Bülent Önal
- Department of Urology, İstanbul University-Cerrahpaşa, Cerahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Elif Altınay Kırlı
- Department of Urology, İstanbul University-Cerrahpaşa, Cerahpaşa Faculty of Medicine, İstanbul, Turkey
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Abstract
PURPOSE OF REVIEW As the incidence of urinary stone disease in children is increasing, identifying dietary risk factors becomes vitally important, especially in the context of targeting interventions to reduce risk for stone formation. Indiscriminant dietary restrictions are not appropriate for paediatric patients. RECENT FINDINGS Although large, prospective studies are still needed to better quantify dietary risk factors for paediatric stone formers, a number of smaller studies provide data to identify common risk factors to help prevent stone formation, while minimizing inappropriate dietary restrictions. SUMMARY Interpretation of 24-h urine samples to identify individualized dietary risk factors is crucial for implementing a strategy for prevention of further urinary stone formation in children. Clinicians should avoid generalized dietary restrictions in stone-forming children uninformed by laboratory data.
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Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol 2020; 35:383-397. [PMID: 30607567 DOI: 10.1007/s00467-018-4179-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 12/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10 years. The most important role of the pediatric nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. OBJECTIVE The purpose of this review is to summarize the existing literature on the etiology and management of pediatric nephrolithiasis. RESULTS The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. CONCLUSIONS Pediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.
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Girişgen İ, Yüksel S, Karcılı K, Becerir T. Evaluation of the composition of urinary tract stones in children from the Inner Western Anatolian Region in Turkey. Turk J Urol 2020; 46:152-158. [PMID: 31922482 PMCID: PMC7053989 DOI: 10.5152/tud.2019.19170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/06/2019] [Indexed: 08/30/2023]
Abstract
OBJECTIVE Pediatric urolithiasis is a globally growing problem. The composition and frequency of urinary tract stones vary not only among different countries, but across various regions in a country. Hence, we aimed to identify the types and frequencies of urinary tract stones in children from our region (Inner Western Anatolian part of Turkey), and to compare our findings with the results from other regions in our country. MATERIAL AND METHODS In this retrospective analysis of 53 pediatric urolithiasis cases that were treated in our hospital between 2009 and 2019, the demographic data, clinical course, radiological and metabolic findings, the recurrence rate, and the composition of the stones were evaluated. RESULTS The mean age of the patients was 5.9±4.6 (0.5-18) years, and there were 30 (56.6%) girls and 23 (43.4%) boys. An analysis of the composition of the stones revealed that the majority (85%) consisted of calcium oxalate. The highest risk of recurrence and the need for multiple shockwave lithotripsy (SWL) sessions or surgical intervention appeared to be related with the presence of whewellite stones, which are the most challenging stones in childhood. CONCLUSION According the study results, the urinary stone types vary across different regions in our country, and the frequency of uric acid stones decreased going westward, while the frequency of oxalate stones increased. We conclude that this difference in the frequency of the type of urinary stones might reflect the regional dietary habits. Regional frequency and etiology studies for the types of urolithiasis may facilitate the approach to the treatment of urolithiasis.
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Affiliation(s)
- İlknur Girişgen
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Nephrology-Rheumatology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Kadriye Karcılı
- Department of Pediatrics, Pamukkale University School of Medicine, Denizli, Turkey
| | - Tülay Becerir
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
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Kita N, Nagao Y, Nabeshima Y, Yamane I, Hirata M, Hatakeyama K. Formation of a calcium oxalate urethral stone in a 3-year-old boy due to hypocitraturia. IJU Case Rep 2020; 3:49-52. [PMID: 32743468 PMCID: PMC7292182 DOI: 10.1002/iju5.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/12/2019] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Urolithiasis in children is often due to metabolic abnormalities (e.g. hypocitraturia) and hence recurs frequently. CASE PRESENTATION A 3-year-old boy presented with gross hematuria. Computed tomography detected a urethral calculus. The calculus was removed surgically. The stone was composed of calcium oxalate. Although oxalate and uric acid levels in the urine were within normal ranges, urine calcium was moderately elevated and urine citrate was substantially low. Urinalyses of the parents revealed that the father had acidic hypocitraturic urine, containing oxalate crystals, and the mother had hypercalciuria. Administration of oral citrate acid normalized urine citrate levels and eliminated the oxalate crystals, from the boy and his father. CONCLUSION Although preventing urolithiasis using oral citrate is common in the adult population, this preventive measure is not well recognized in children, thus warranting further study.
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Affiliation(s)
- Nobuhisa Kita
- Department of PediatricsFukuoka Tokushukai HospitalKasugaFukuokaJapan
| | - Yoshiro Nagao
- Department of PediatricsFukuoka Tokushukai HospitalKasugaFukuokaJapan
| | | | - Ichiro Yamane
- Department of PediatricsFukuoka Tokushukai HospitalKasugaFukuokaJapan
| | - Masaaki Hirata
- Department of PediatricsFukuoka Tokushukai HospitalKasugaFukuokaJapan
| | - Kuniya Hatakeyama
- Department of PediatricsFukuoka Tokushukai HospitalKasugaFukuokaJapan
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Bozkurt HB, Çetin T, Sarıca K. The Possible Beneficial Effect of Breastfeeding on the Clinical Course of Urolithiasis Detected During Infancy. Breastfeed Med 2020; 15:84-89. [PMID: 31928369 DOI: 10.1089/bfm.2019.0236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim: To evaluate the possible effect of breastfeeding duration on the clinical course and treatment of stones detected during infancy. Materials and Methods: Forty-eight infants with renal stones diagnosed between 0 and 23 months were included in this retrospective cohort study. The children were called for regular follow-up visits for the evaluation of physical examination findings, renal size and parenchymal thickness measured by ultrasonography, localization, size and number of stones, spot urine analysis data, metabolic evaluation findings, and duration of breastfeeding and formula use. The relationship between the disease course (progression or stability) and the duration of breastfeeding were assessed from different aspects by considering the original characteristics of the stones at the time of first diagnosis. Results: The mean follow-up period was 46.21 ± 23.22 months, and the most important metabolic risk factor was hypercalciuria with a rate of 29.2%. The mean duration of breast milk intake was longer in children with no disease progression and in those with a reduced size and/or number of stones. The children receiving only breast milk for the first 6 months of life required treatment less and had less growth retardation. Conclusions: Our findings suggest that breastfeeding has critical effects on infantile urolithiasis. Breastfeeding should be encouraged in children with stones particularly detected during infancy. Further studies with a larger case series are needed to reveal the positive effects of breast milk on the clinical course of urolithiasis in children.
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Affiliation(s)
| | - Türkhun Çetin
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kemal Sarıca
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
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Baydilli N, Tosun H, Akınsal EC, Gölbaşı A, Yel S, Demirci D. Effectiveness and complications of mini-percutaneous nephrolithotomy in children: one center experience with 232 kidney units. Turk J Urol 2019; 46:69-75. [PMID: 31747365 DOI: 10.5152/tud.2019.19158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy and complications of mini-percutaneous nephrolithotomy (PCNL) surgery using 14-20 Fr access sheaths in pediatric patients, as well as the results of postoperative stone analysis and metabolic urine analysis. MATERIAL AND METHODS We retrospectively evaluated the records of 206 pediatric patients (232 kidney units) who underwent mini-PCNL for kidney stones in our clinic between February 2011 and December 2018. We evaluated the demographic characteristics, complications, stone-free rates, and the results of chemical analysis and urinary metabolic analysis. RESULTS The age ranged from 9 months to 16 years. The mean age was 5.1±3.9 years, and the median age was 3.5 years. The median stone burden was 200 mm2 (min: 100; max: 1600). Kidney stones were most commonly located in the pelvis in 118 (50.9%) patients, followed by lower calyceal stones in 42 (18.1%) and multiple calyceal stones in 38 (16.4%) patients, respectively. While the success of mini-PCNL was 80.6% after the first session, this rate increased to 87.9% after auxiliary treatments. The total complication rate was 12.9% according to modified Clavien classification. A postoperative stone analysis showed that calcium oxalate had the highest frequency with 61.1% of patients, followed by cystine stone with 21.3% of patients. Metabolic urine analysis revealed no abnormalities in 42.8% of patients. The most common metabolic abnormality was hyperoxaluria (32%), followed by hypercalcuria (19.6%). CONCLUSION Mini-PCNL is a safe and effective procedure with reasonable complications for the treatment of pediatric kidney stones. All kinds of multidisciplinary efforts are required to remove kidney stones completely in pediatric patients.
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Affiliation(s)
- Numan Baydilli
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Halil Tosun
- Department of Pediatric Urology, University of Health Sciences, Ankara Child Health and Disease Hematology Oncology Research Hospital, Ankara, Turkey
| | - Emre Can Akınsal
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdullah Gölbaşı
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Deniz Demirci
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
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Urinary biomarkers in the early detection and follow-up of tubular injury in childhood urolithiasis. Clin Exp Nephrol 2017; 22:133-141. [PMID: 28653226 DOI: 10.1007/s10157-017-1436-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND To investigate relationships among urinary biomarkers [kidney injury molecule-1 (KIM-1), N-acetyl-β-glucosaminidase (NAG)], neutrophil gelatinase-associated lipocalin (NGAL) levels and renal tubular injury in childhood urolithiasis. METHODS Seventy children [36 girls, mean age: 7.3 ± 5.0 years (0.5-18.2)] with urolithiasis/microlithiasis and 42 controls [18 girls, mean age: 8.5 ± 3.8 years (0.9-16.2)] were included in this multicenter, controlled, prospective cohort study. Patients were evaluated three times in 6-month intervals (0, 6 and 12th months). Anthropometric data, urinary symptoms, family history and diagnostic studies were recorded. Urine samples were analyzed for metabolic risk factors (urinary calcium, uric acid, oxalate, citrate, cystine, magnesium, and creatinine excretion), and the urinary KIM-1, NAG, and NGAL levels were measured. RESULTS Stones were mostly located in the upper urinary system (82.9%), and six patients (8.6%) had hydronephrosis. Thirty patients (42.9%) had several metabolic risk factors, and the most common metabolic risk factor was hypocitraturia (22.9%). Urinary KIM-1/Cr, NAG/Cr and NGAL/Cr ratios were not significantly different between patients and controls. Furthermore, no significant changes in their excretion were shown during follow-up. Notably, the urinary KIM-1/Cr, NAG/Cr, and NGAL/Cr levels were significantly higher in children under 2 years of age (p = 0.011, p = 0.006, and 0.015, respectively). NAG/Cr and NGAL/Cr ratios were significantly increased in patients with hydronephrosis (n = 6, p = 0.031 and 0.023, respectively). CONCLUSIONS The results of this study suggest that none of the aforementioned urinary biomarkers (KIM-1, NAG and NGAL levels) may be useful for the early detection and/or follow-up of renal tubular injury and/or dysfunction in childhood urolithiasis.
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Takeuchi M, Yasunaga H, Matsui H, Fushimi K. Pediatric urolithiasis associated with acute gastroenteritis: an inpatient database study in Japan. Eur J Pediatr 2017; 176:501-507. [PMID: 28175995 DOI: 10.1007/s00431-017-2865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED Pediatric urolithiasis associated with acute gastroenteritis (AGE) has not been systematically investigated, including its prevalence, risk estimate, and outcome. Using a national inpatient database in Japan, we searched for children (≤59 months old) who were hospitalized for AGE and those complicated by urolithiasis over a 24-month period. We found 23 cases of urolithiasis among 62,800 children who were hospitalized for AGE (3.7 cases/10,000 AGE admissions). AGE was associated with an increased risk of urolithiasis (odds ratio 2.01; p = 0.015). The patients' mean age was 24 months and there was male dominance. Four patients had chronic medical conditions, including two with renal conditions. None of the patients had congenital metabolic disorders. Nine patients had causative agents for AGE, including rotavirus (n = 5), norovirus (n = 2), and bacteria (n = 2). Two patients required placement of a nephrostomy tube and the remaining 21 patients were discharged without invasive procedures. CONCLUSION Childhood AGE is associated with a twofold risk of urolithiasis in a hospitalized cohort, but the absolute risk is low. Our study shows that AGE-related urolithiasis occurs through a variety of pathogens, and the outcomes of patients are favorable, which is in contrast to previous reports. What is Known: • There are several sporadic reports of pediatric urolithiasis associated with acute gastroenteritis (AGE), predominantly from Japan. • The epidemiology of AGE-related urolithiasis is however unclear. What is New: • AGE is associated with a two-fold risk of urolithiasis in a hospitalized cohort, with its absolute risk of 3.7 cases/10,000 AGE admissions.
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Affiliation(s)
- Masato Takeuchi
- Department of Pediatrics, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, 278-0005, Japan. .,Department of Pediatrics, The University of Tokyo, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan.,Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Why we need a higher suspicion index of urolithiasis in children. J Pediatr Urol 2017; 13:164-171. [PMID: 28185760 DOI: 10.1016/j.jpurol.2016.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms. STUDY DESIGN We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures. CONCLUSIONS It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.
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Carvalho-Salemi J, Moreno L, Michael M. Medical Nutrition Therapy for Pediatric Kidney Stone Prevention, Part Two. J Ren Nutr 2017; 27:e11-e14. [DOI: 10.1053/j.jrn.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 11/11/2022] Open
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The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: A systematic review and meta-analysis. J Pediatr Surg 2017; 52:360-365. [PMID: 27837990 DOI: 10.1016/j.jpedsurg.2016.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/13/2016] [Accepted: 10/04/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We carried out a systematic review and meta-analysis to evaluate the efficacy and safety of adrenergic alpha-antagonists as a medical expulsive therapy for ureteral stones in pediatric patients. METHODS The PubMed, EMBASE and Cochrane Controlled Trials Register databases were searched up to January 2016. All randomized controlled trials and all cohort studies in which patients were randomized to receive either adrenergic alpha-antagonists or placebo for ureteral stones were identified. The outcome measures assessed were overall stone expulsion rate (primary), expulsion time (secondary), and treatment-emergent adverse events. RESULTS Five trials with a total of 406 pediatric patients met the inclusion criteria. According to the doses of adrenergic alpha-antagonists, the pooling effects of adrenergic alpha-antagonists were analyzed, with a higher expulsion rate obtained than in controls, the stone expulsion rate (OR=2.70, 95% CI 1.49 to 4.91, P=0.001). Adrenergic alpha-antagonists statistically did not significantly decrease the number of the stone expulsion time with the placebo, the stone expulsion time (SMD=-4.65, 95% CI -9.76 to 0.45, P=0.07). Safety assessments included common treatment-emergent adverse events (TEAEs) (OR=2.01, 95% CI 0.74 to 5.48, P=0.17). Compared with placebos, there was a higher stone expulsion rate with the adrenergic alpha-antagonists; in addition, fewer adverse effects were observed. CONCLUSIONS This meta-analysis may suggest that adrenergic alpha-antagonists are a safe and effective medical expulsive therapy choice for ureteral stones in pediatric patients. As the level of classification of evidence-based medicine, the level of evidence of our article is Ia. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed. LEVEL OF EVIDENCE The level of evidence of our study is V.
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Carvalho-Salemi J, Moreno L, Michael M. Medical Nutrition Therapy for Pediatric Kidney Stone Prevention, Part One. J Ren Nutr 2017; 27:e5-e8. [DOI: 10.1053/j.jrn.2016.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022] Open
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Bandari J, Dangle PP, Lyon TD, Lee A, Schneck FX, Cannon GM, Stephany HA, Ost MC. 24-Hour Urinary Parameters in Overweight and Obese Children with Urolithiasis. J Urol 2016; 196:526-30. [DOI: 10.1016/j.juro.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pankaj P. Dangle
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy D. Lyon
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andy Lee
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Francis X. Schneck
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Glenn M. Cannon
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heidi A. Stephany
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael C. Ost
- Division of Urology, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Çaltık Yılmaz A, Büyükkaragöz B, Oguz U, Çelik B. Influence of body mass index on pediatric urolithiasis. J Pediatr Urol 2015; 11:350.e1-6. [PMID: 26182848 DOI: 10.1016/j.jpurol.2015.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In recent years, there has been increased incidence of urolithiasis in children. Changing nutritional patterns and sedentary lifestyles predispose to urolithiasis, as well as to the global rise in obesity. It has been established that the prevalence of high body mass index (BMI) is increasing in the pediatric population. The aim of the present study was to incorporate 24-h urine metabolic analysis results with BMI values to evaluate the tendency towards stone formation in children. METHODS Eighty-four children were recruited to the study, stratified into three BMI categories as low, normal, or upper. All patients were evaluated with 24-h urine analysis results. Patients with a secondary cause of stone formation such as hyperparathyroidism, cystinuria, primary hyperoxaluria, inflammatory bowel disease, cystic fibrosis, history of prematurity and/or use of drug, recurrent urinary tract infection, and urinary tract anomaly were excluded. Additionally, it was ensured that none of the patients were taking specific medication or diet that could alter their acid-base metabolism and calcium, oxalate, and uric acid levels. RESULTS Mean BMI of patients was 21.6 ± 2.9 kg/m(2). LBMI was found in 52 (61.9%), N-BMI in 20 (23.8%), and U-BMI in 12 (14.3%) of the patients. No significant differences were present between the three groups for stone sizes and numbers. The patients' characteristics and 24-h urine parameters for BMI groups are presented in the Table. DISCUSSION In the literature, several studies have focused on the relationship between obesity and pediatric urinary stone disease. However, only a few evaluated the urinary metabolic analysis in pediatric patients. We have encountered different results from mainly adult studies and some pediatric studies. Our study shows that U-BMI children are not under greater risk for urolithiasis than the other groups. An important portion of our study group was in the L-BMI group; nevertheless we cannot conclude that having a low BMI predisposes to urolithiasis based on the urinary metabolic evaluation as well as the stone sizes and numbers. The N-BMI group has increased risk factors for urolithiasis rather than the other groups, according to results of 24-h urine analysis. CONCLUSION The results of our study indicate that BMI itself could not be considered as a separate and definite risk factor for urolithiasis development in children. Although the mechanisms and causative factors for urinary stone formation are better defined in adults, further studies investigating these parameters in children are warranted.
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Affiliation(s)
- Aysun Çaltık Yılmaz
- Ankara Kecioren Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Turkey.
| | - Bahar Büyükkaragöz
- Ankara Kecioren Training and Research Hospital, Department of Pediatric Nephrology, Ankara, Turkey
| | - Ural Oguz
- Ankara Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey
| | - Bülent Çelik
- Gazi University, Faculty of Arts and Sciences, Department of Statistics, Ankara, Turkey
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Penido MGMG, Tavares MDS. Pediatric primary urolithiasis: Symptoms, medical management and prevention strategies. World J Nephrol 2015; 4:444-454. [PMID: 26380196 PMCID: PMC4561842 DOI: 10.5527/wjn.v4.i4.444] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
In the past few decades pediatric urolithiasis has become more frequent. The reason for this increase is not completely clear but has been attributed to changes in climate, nutritional habits and possibly other environmental factors. Although less frequent than adult stone disease, urolithiasis in the pediatric age group is also related to significant morbidity, particularly since stones tend to recur, and, thus, should not be underestimated. Most children with idiopathic stone disease have an underlying metabolic abnormality substantiating the importance of metabolic evaluation already following initial diagnosis of urolithiasis. Identification of the metabolic abnormality allows for more specific prescription of non pharmacological and pharmacological interventions aimed at preventing recurrent stone formation. A better understanding of the causes of kidney stone disease will provide better strategies for stone prevention in children.
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Taguchi K, Hamamoto S, Okada A, Mizuno K, Tozawa K, Hayashi Y, Kohri K, Yasui T. First case report of staghorn calculi successfully removed by mini-endoscopic combined intrarenal surgery in a 2-year-old boy. Int J Urol 2015; 22:978-80. [DOI: 10.1111/iju.12860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/04/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Shuzo Hamamoto
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Atsushi Okada
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Kentaro Mizuno
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Keiichi Tozawa
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Yutaro Hayashi
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Kenjiro Kohri
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Takahiro Yasui
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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Okada S, Azuma Y, Kaneyasu H, Mizutani M, Korenaga Y, Kittaka S, Suzuki Y, Ohnishi Y, Furuta T, Ohga S. Takotsubo (stress) cardiomyopathy and obstructive renal stones in an infant with norovirus gastroenteritis. Int J Cardiol 2015; 186:233-5. [DOI: 10.1016/j.ijcard.2015.03.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/17/2015] [Indexed: 01/11/2023]
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Piccoli GB, Cimmino MA, Lamp M, Gotta F, Vigotti FN, Priola AM, Veltri A, Mandich P. Quiz Page February 2015. Am J Kidney Dis 2015; 65:A17-9. [DOI: 10.1053/j.ajkd.2014.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/01/2014] [Indexed: 11/11/2022]
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Does obesity or hyperuricemia influence lithogenic risk profile in children with urolithiasis? Pediatr Nephrol 2015; 30:797-803. [PMID: 25380789 PMCID: PMC4372672 DOI: 10.1007/s00467-014-2999-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/09/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are indications that obesity and hyperuricemia may influence the formation and composition of urinary stones. The aim of our study was to determine the effect of obesity and hyperuricemia on the urinary lithogenic risk profile in a large cohort of pediatric patients. METHODS The study population comprised 478 children with urolithiasis and 517 healthy children (reference group). We studied the effects of obesity on the lithogenic profile by dividing the patients with urolithiasis into two groups based on body mass index Z-score (patients who were overweight/obese vs. those with normal weight for age) and comparing the two groups. To study the effect of hyperuricemia on the lithogenic profile, we divided the patients with urolithiasis into two groups based on the presence or not of hyperuricemia (110 patients with urolithiasis accompanied by hyperuricemia vs. 368 patients with urolithiasis and normal serum uric acid levels) and compared the groups. RESULTS Among the children and adolescents with urolithiasis and hyperuricemia, there was a significantly lower excretion of crystallization inhibitors (citrates, magnesium). We also found significantly negative correlations between serum uric acid levels and the urine citrate/creatinine ratio (citrate/cr.; r = -0.30, p < 0.01), as well as the magnesium/cr. ratio (Mg/cr.; r = -0.33, p < 0.01). There was no statistically significant differences in the urinary excretion of oxalates, citrates, calcium, phosphorus, magnesium and uric acid between children with urolithiasis who were either overweight or obese and children with urolithiasis who had a normal body weight. CONCLUSIONS In our pediatric patient cohort, hyperuricemia was associated with a decrease in the excretion of crystallization inhibitors in the urine, but the clinical relevance of this observation needs to be confirmed in future studies. Obesity and overweight had no direct influence on the lithogenic risk profile in the urinary stone formers in our study, but there was an indication that higher serum uric acid may be associated with impairment in renal function, which in turn could influence the excretion of lithogenic parameters.
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Göknar N, Oktem F, Arı E, Demir AD, Torun E. Is oxidative stress related to childhood urolithiasis? Pediatr Nephrol 2014; 29:1381-6. [PMID: 24526098 DOI: 10.1007/s00467-014-2773-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/10/2014] [Accepted: 01/22/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urolithiasis is a common condition in pediatric populations in Turkey. The role of oxidative stress in renal stone formation in pediatric patients has not been reported to date. The aim of this study was to assess oxidative stress in childhood urolithiasis. METHODS Seventy-four children diagnosed with urolithiasis and 72 healthy control subjects were enrolled in the study. Kidney stone formers were evaluated by analysis of metabolic conditions related to urolithiasis, such as hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. Urine total antioxidant status (TAS), and total oxidant status (TOS) were measured, and oxidative stress index (OSI) was calculated as an indicator of the degree of oxidative stress. RESULTS Among the stone formers, metabolic analyses revealed that 30 % had hypercalciuria, 45 % had hypocitraturia, 6 % had hyperoxaluria and 40 % had hyperuricosuria. Elevated levels of the renal tubular damage marker urinary N-acetyl- beta-D-glucosaminidase (NAG) was elevated in 25 % of the patient group, but microalbuminuria was not detected. Total oxidant status and total antioxidant status were significantly higher in stone formers than in the controls (p = 0.023 and 0.004, respectively). In addition, urinary NAG was significantly correlated with TOS (r = 0.427, p = 0.019). CONCLUSIONS The results of this study show that oxidative stress may play an important role in the pathogenesis of pediatric stone formers.
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Affiliation(s)
- Nilufer Göknar
- Department of Pediatric Nephrology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
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Analysis of Urinary Parameters as Risk Factors for Nephrolithiasis in Children with Celiac Disease. J Urol 2012; 188:566-70. [DOI: 10.1016/j.juro.2012.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Indexed: 11/24/2022]
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