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Gefen AM, Zaritsky JJ. Review of childhood genetic nephrolithiasis and nephrocalcinosis. Front Genet 2024; 15:1381174. [PMID: 38606357 PMCID: PMC11007102 DOI: 10.3389/fgene.2024.1381174] [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] [Received: 02/03/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Nephrolithiasis (NL) is a common condition worldwide. The incidence of NL and nephrocalcinosis (NC) has been increasing, along with their associated morbidity and economic burden. The etiology of NL and NC is multifactorial and includes both environmental components and genetic components, with multiple studies showing high heritability. Causative gene variants have been detected in up to 32% of children with NL and NC. Children with NL and NC are genotypically heterogenous, but often phenotypically relatively homogenous, and there are subsequently little data on the predictors of genetic childhood NL and NC. Most genetic diseases associated with NL and NC are secondary to hypercalciuria, including those secondary to hypercalcemia, renal phosphate wasting, renal magnesium wasting, distal renal tubular acidosis (RTA), proximal tubulopathies, mixed or variable tubulopathies, Bartter syndrome, hyperaldosteronism and pseudohyperaldosteronism, and hyperparathyroidism and hypoparathyroidism. The remaining minority of genetic diseases associated with NL and NC are secondary to hyperoxaluria, cystinuria, hyperuricosuria, xanthinuria, other metabolic disorders, and multifactorial etiologies. Genome-wide association studies (GWAS) in adults have identified multiple polygenic traits associated with NL and NC, often involving genes that are involved in calcium, phosphorus, magnesium, and vitamin D homeostasis. Compared to adults, there is a relative paucity of studies in children with NL and NC. This review aims to focus on the genetic component of NL and NC in children.
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Affiliation(s)
- Ashley M. Gefen
- Phoenix Children’s Hospital, Department of Pediatrics, Division of Nephrology, Phoenix, AZ, United States
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Wang Z, He T, liu L, Tong F, Li C, Zhao Y, Li Y. Use of whole-exome sequencing to identify novel monogenic gene mutations and genotype-phenotype correlations in Chinese Han children with urolithiasis. Front Genet 2023; 14:1128884. [PMID: 37144129 PMCID: PMC10152365 DOI: 10.3389/fgene.2023.1128884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/20/2023] [Indexed: 05/06/2023] Open
Abstract
The incidence of urolithiasis (UL) in children has been increasing. Although the pathogenesis of pediatric UL is controversial and remains unclear, multiple monogenic causes of UL have been identified. We aim to investigate the prevalence of inherited UL causes and explore the genotype-phenotype correlation in a Chinese pediatric group. In this study, we analyzed the DNA of 82 pediatric UL patients using exome sequencing (ES). The data of metabolic evaluation and genomic sequencing were subsequently analyzed together. We detected 54 genetic mutations in 12 of 30 UL-related genes. A total of 15 detected variants were described as pathogenic mutations, and 12 mutations were considered likely pathogenic. Molecular diagnoses were made in 21 patients with pathogenic or likely pathogenic variants. Six novel mutations that were not previously reported were identified in this cohort. Calcium oxalate stones were detected in 88.9% cases (8/9) with hyperoxaluria-related mutations, while 80% of individuals (4/5) with cystinuria-causing defects were diagnosed with cystine stones. Our study highlights the significant genetic abnormalities in pediatric UL and demonstrates the diagnostic power of ES for screening patients with UL.
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Abstract
The incidence of kidney stones in children is increasing. Approximately two-thirds of pediatric cases have a predisposing cause. Children with recurrent kidney stones have an increased higher risk of developing chronic kidney. A complete metabolic workup should be performed. Ultrasound examination is the initial imaging modality recommended for all children with suspected nephrolithiasis. A general dietary recommendation includes high fluid consumption, dietary salt restriction, and increased intake of vegetables and fruits. Depending on size and location of the stone, surgical intervention may be necessary. Multidisciplinary management is key to successful treatment and prevention.
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Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Michigan State University and Central Michigan University, Stone Clinic, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit 48201, MI, USA.
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Jayman J, Gibbs H, Mathias R, Epelman M, Ellsworth P. Progression of asymptomatic nephrolithiasis in children: How often should patients receive follow-up ultrasound imaging? J Pediatr Urol 2022; 18:25.e1-25.e8. [PMID: 34756785 DOI: 10.1016/j.jpurol.2021.10.010] [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: 07/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural history of asymptomatic nephrolithiasis (AN) in children is not well defined. Furthermore, there is no guidance on the utility of repeated renal ultrasound evaluations in this same population. Follow-up ultrasound studies are often obtained as frequently as every 6 months. The goal of this study is to assess the follow-up ultrasound interval in the management of these patients. METHODS A retrospective IRB approved chart review was performed for patients seen for non-cysteine AN between 2012 and 2019. AN was defined as patients without obstructive uropathy abdominal, flank pain and/or gross hematuria. Asymptomatic stones were discovered incidentally or after an acute stone event. Patients with pre-existing renal anomalies and the timepoints with stone passage or stone procedure were excluded. Descriptive statistics were used for demographic information. Multiple linear regression was used to analyze risk factors. Statistical significance was set to p < 0.05. RESULTS Twenty-nine patients had 90 ultrasounds. The average age at diagnosis was 10.8 ± 6.2 years. The average number of ultrasound studies per patient was 3.2 ± 1.7. The median time between follow-up ultrasounds was 5.2 months [IQR 2.8-10.0]. Median follow-up of patients was 10.6 months [IQR 4.9-21.9]. The change in total stone burden occurred at a rate of 0.11 mm/month (CI [-0.06-0.28], p = 0.20, r2 = 0.42) or 0.66 mm/6 months. Patients with more renal stones had almost a threefold increase in stone burden compared to patients with fewer renal stones (2.98 [CI 1.34-4.62], p=0.001, r2=0.33). Patients with a family history of stones had a twofold increase in the size of their largest stone when compared to patients without a family history (1.97 [CI 0.26-3.68], p=0.02, r2=0.60. CONCLUSION A complex interplay of multiple factors influence the progression of AN in children. Children with a greater number of stones have a higher increase in total stone burden and children with a family history of stones have a faster increase in largest stone size. These patients may require more frequent imaging studies. The small change in stone size over time favors a longer than 6-month interval for many children.
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Affiliation(s)
- John Jayman
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Hannah Gibbs
- University of Central Florida School of Medicine, Orlando, FL, USA
| | - Robert Mathias
- Division of Nephrology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Monica Epelman
- Division of Radiology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA
| | - Pamela Ellsworth
- Division of Pediatric Urology, Nemours Children's Hospital, Nemours Healthcare System, Orlando, FL, USA.
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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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Zhong J, Huang Z, Yang T, Wang G, Guo H, Li P, Zhang Y, Zhao Y, Liu J. The current status of preventive measures for urinary calculi in children. Ther Adv Urol 2021; 13:17562872211039581. [PMID: 34422114 PMCID: PMC8371722 DOI: 10.1177/17562872211039581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Urological calculus is a common disease in urology. Urological calculi are
generally more common in adults but have become more common in children in
recent years. Most existing studies focus on the prevention of urinary calculi
in adults; there are relatively few articles on calculi in children. Reported
preventive measures are not comprehensive enough, while the latest research
progress has not been updated. The pathogenesis and preventive measures
associated with urinary calculi have been the focus of research, but many
preventive measures still need further clarification. This article reviews the
progress on preventive measures for urinary calculi in children.
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Affiliation(s)
- Jiao Zhong
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Haixiang Guo
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yafei Zhang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yuan Zhao
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, P.R. China
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Qiu Z, Guo QB, Ablikim Z, Shi XW, Hou JJ, Chen C, Hasanjan M, Akbarjan M, Anwar A. Safety and efficacy of ultrasound-guided low-pressure perfusion mini-percutaneous nephrolithotomy in children aged 1-7 years: a retrospective observational study. Int Urol Nephrol 2021; 53:1969-1976. [PMID: 34216340 DOI: 10.1007/s11255-021-02933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This article analyzed the safety and efficacy of ultrasound-guided mini-percutaneous nephrolithotomy (MPCNL) with low-pressure perfusion for the treatment of upper urinary tract stones in children. METHODS The clinical data of 690 patients (805 renal units) aged 1-7 years were retrospectively analyzed in terms of postoperative outcome. RESULTS The mean patient age was 3.7 ± 1.6 years, and the stone burden was 2.8 ± 2.1 cm2. A middle posterior calyceal puncture was created in 719 (89%) renal units, and 16F puncture tracts were the most common method used in 557 (69%) renal units. The stone-free rate was 711 (88%) renal units, and the mean operation time was 35 ± 15.3 min (between 15 and 110 min). Among all cases, the transfusion rate was 4 (0.6%) patients, and the mean decrease in hemoglobin was 1.3 ± 0.9 g/L. In addition, the incidence rates of fever, sepsis, perirenal effusion, and intraperitoneal effusion were 40 (5.9%), 3 (0.4%), 28 (4.1%), and 8 (1.2%) patients, respectively. After the operation, 348 patients were followed-up for 32.8 ± 11.3 months, and stone recurrence occurred in 136 (39%) of 348 patients. CONCLUSIONS This study suggests that ultrasound-guided MPCNL with low-pressure perfusion technology is a safe and feasible treatment.
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Affiliation(s)
- Zhi Qiu
- Department of Urology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China. .,Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China.
| | - Quan-Bin Guo
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Zakir Ablikim
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Xu-Wen Shi
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Jiang-Jiang Hou
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Chang Chen
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Mamat Hasanjan
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Mamat Akbarjan
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
| | - Abdukadir Anwar
- Department of Urology, Hotan People's Hospital, Hotan, 848000, Xinjiang Uyghur Autonomous Region, China
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Wen J, Cao Y, Li Y, Zhu F, Yuan M, Xu J, Li J. Metabolomics analysis of the serum from children with urolithiasis using UPLC-MS. Clin Transl Sci 2021; 14:1327-1337. [PMID: 33580996 PMCID: PMC8301561 DOI: 10.1111/cts.12984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023] Open
Abstract
Pediatric urolithiasis is a common urologic disease with high morbidity and recurrence rates. Recent studies have shown that metabolic dysfunction plays a vital role in the pathogenesis of urolithiasis, especially in children, but the specific mechanism is still unclear. Metabolomics is an ideal technology for exploring the mechanism of metabolic disorders in urolithiasis. In the present study, a serum metabolomics based on ultra‐performance liquid chromatography mass spectrometry was performed. A total of 50 children subjects were recruited for the study, including 30 patients with kidney stones and 20 normal controls (NCs). Principal component analysis and orthogonal partial least‐squares determinant analysis were carried, and 40 metabolites were found to be significantly altered in patients with kidney stones, mainly involving retinol metabolism, steroid hormone biosynthesis, and porphyrin and chlorophyll metabolism. The kidney stone group appeared to have a lower serum level of bilirubin, but a relative higher level of retinal, all‐transretinoic acid, progesterone, and prostaglandin E2 compared with those of the NC group. All the findings suggest that patients with urolithiasis have several metabolic characteristics, which are related to stone formation or compensation. These metabolites and pathways are very likely associated with development of kidney stones and should be considered as potential novel targets for treatment and prevention.
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Affiliation(s)
- Junxiang Wen
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yinyin Cao
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Fenhua Zhu
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Meifen Yuan
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jin Xu
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jian Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Birth Defect, Shanghai, China
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9
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Abstract
Pediatric nephrolithiasis is a disease of increasing prevalence and economic burden, with data showing a rising trend among girls and adolescents. Kidney stones in children tend to have a high recurrence rate related to underlying risk factors, and the aim of evaluation should be to understand such causes so that targeted therapy can be provided to decrease recurrence and complications. Metabolic, anatomic, and genetic abnormalities as well as environmental risk factors have all been implicated in the pathogenesis of nephrolithiasis. Recent studies have focused on identifying monogenic causes of nephrolithiasis and/or nephrocalcinosis in young patients that would result in personalization of treatment as well as future diagnostic implications for family members. Treatment aims to decrease stone burden and recurrence as well as minimize complications and is guided by stone size and location as well as surgical expertise. Multidisciplinary care for these patients has been on the rise to provide a more comprehensive medical and surgical support. [Pediatr Ann. 2020;49(6):e262-e267.].
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Li Y, Bayne D, Wiener S, Ahn J, Stoller M, Chi T. Stone formation in patients less than 20 years of age is associated with higher rates of stone recurrence: Results from the Registry for Stones of the Kidney and Ureter (ReSKU). J Pediatr Urol 2020; 16:373.e1-373.e6. [PMID: 32280060 PMCID: PMC7308197 DOI: 10.1016/j.jpurol.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/17/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Nephrolithiasis is a major source of morbidity in the United States. In recent decades, there has been a notable increase in stone incidence in the pediatric population. We investigate whether recurrent stone formers who had their initial stone episode earlier in life are at risk for more frequent stone recurrences, compared to those with initial episodes later in life. We also examine possible risk factors that might change our approach to treatment of these patients. METHODS A review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to compare stone recurrence and other patient factors in patients who reported an initial stone episode prior to 20 years of age versus patients who reported an initial stone episode after age 20. Data on patient age, gender, BMI, family history, race, income, infectious symptoms, and number of prior stone episodes was analyzed. We excluded patients with a history of cystinuria stones. Univariate analysis was performed using Fisher's exact test and student's T test. Multivariate analysis was performed using logistic regression. RESULTS Of the 1140 patients enrolled during this study period, 472 patients were recurrent stone formers, and of these, 66 had their first stone episode prior to the age of 20. On univariate analysis, early stone formers were more likely to be female, present at a younger age, and have more prior stone episodes on enrollment. Using multivariate modelling to control for age, gender, race, BMI, family history, and number of stone episodes, early stone formers were more likely to be female (CI 1.17 - 3.54) and have more than one prior stone episode (CI 1.13 - 3.78). Late stone formers were more likely to have BMI > 30 (CI 0.26 - 0.94). CONCLUSION Recurrent stone formers who have their first episodes prior to age 20 are more likely to present to stone clinics with multiple prior recurrences and hence more aggressive stone disease. Female gender seems to be a risk factor. Earlier stone formers should be encouraged to have close follow up and surveillance due to the increased rate of recurrence. Adult stone databases focusing on early presentations can improve understanding of pediatric stone disease.
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Affiliation(s)
- Yi Li
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
| | - David Bayne
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
| | - Scott Wiener
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
| | - Justin Ahn
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
| | - Marshall Stoller
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
| | - Thomas Chi
- University of California, San Francisco, Department of Urology, 400 Parnassus Ave., A610, San Francisco, CA 94143, USA.
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Kovacevic L, Lu H, Kovacevic N, Lakshmanan Y. Effect of bisphosphonates on the crystallization of stone-forming salts in synthetic urine. Investig Clin Urol 2020; 61:310-315. [PMID: 32377608 PMCID: PMC7189110 DOI: 10.4111/icu.2020.61.3.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/01/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose We investigated the inhibitory effect of bisphosphonates (BPs) on the crystallization of calcium oxalate monohydrate (COM), calcium phosphate (CaP), and magnesium ammonium phosphate (MAP) in synthetic urine, aiming to see 1) which specific BPs work best on a particular type of crystal and 2) what is the lowest concentration of BPs that inhibits crystal formation. Materials and Methods Crystals from synthetic urine were exposed to different concentrations of BPs. Urinary turbidity was used as a marker of crystallization and was measured by spectrophotometry by use of a validated method in our laboratory. The percent inhibitory activity (IA) was calculated by using the formula: (a−b )/a×100, where a is baseline maximal turbidity and b is maximal turbidity with various concentrations of medication. Potassium citrate and magnesium citrate were used as positive controls. Results At the lowest dose of 0.001 mg/mL, risedronate induced the highest IA of 37% on CaP, whereas ibandronate had the strongest IA on COM (24%). To initiate the inhibition of MAP crystallization, risedronate required a two-fold higher concentration (0.002 mg/mL) to reach 30% IA, whereas etidronate required a four-fold higher concentration (0.004 mg/mL) to reach 42% IA. Conclusions BPs are good inhibitors of crystallization in synthetic urine, with risedronate and ibandronate being the most potent. At a low clinically acceptable dose, their highest inhibitory action was on CaP and COM crystals. Higher doses were needed to prevent MAP crystallization. Further investigation of the use of BPs in kidney stone prevention is warranted.
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Affiliation(s)
- Larisa Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Hong Lu
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Natalija Kovacevic
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA.,Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Yegappan Lakshmanan
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, USA
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Destro F, Selvaggio GGO, Lima M, Riccipetitoni G, Klersy C, Di Salvo N, Marinoni F, Calcaterra V, Pelizzo G. Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery. Front Pediatr 2020; 8:377. [PMID: 32793523 PMCID: PMC7393988 DOI: 10.3389/fped.2020.00377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment. Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered. Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent. Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
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Affiliation(s)
- Francesca Destro
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Mario Lima
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Catherine Klersy
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Neil Di Salvo
- Pediatric Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.,Pediatric Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Science L. Sacco, University of Milan, Milan, Italy
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Sighinolfi MC, Eissa A, Bevilacqua L, Zoeir A, Ciarlariello S, Morini E, Puliatti S, Durante V, Ceccarelli PL, Micali S, Bianchi G, Rocco B. Drug-Induced Urolithiasis in Pediatric Patients. Paediatr Drugs 2019; 21:323-344. [PMID: 31541411 DOI: 10.1007/s40272-019-00355-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi.
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Affiliation(s)
- Maria Chiara Sighinolfi
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy.
| | - Ahmed Eissa
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Luigi Bevilacqua
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Ahmed Zoeir
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Silvia Ciarlariello
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Elena Morini
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Viviana Durante
- Pediatric Surgery Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Pier Luca Ceccarelli
- Pediatric Surgery Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena & Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
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