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Mandal A, Khandelwal P, Geetha TS, Murugan S, Meena J, Jana M, Sinha A, Kumar R, Seth A, Hari P, Bagga A. Metabolic and Genetic Evaluation in Children with Nephrolithiasis. Indian J Pediatr 2022; 89:1243-1250. [PMID: 35819704 DOI: 10.1007/s12098-022-04234-9] [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: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate metabolic and genetic abnormalities in children with nephrolithiasis attending a referral center in North India. METHODS The patients aged 1-18 y old with nephrolithiasis underwent biochemical evaluation and whole-exome sequencing. The authors evaluated for monogenic variants in 56 genes and compared allele frequency of 39 reported polymorphisms between patients and 1739 controls from the GenomeAsia 100 K database. RESULTS Fifty-four patients, aged 9.1 ± 3.7 y were included. Stones were bilateral in 42.6%, familial in 33.3%, and recurrent in 25.9%. The most common metabolic abnormalities were hypercalciuria (35.2%), hyperoxaluria (24.1%), or both (11.1%), while xanthinuria (n = 3), cystinuria (n = 1), and hyperuricosuria (n = 1) were rare. Exome sequencing identified an etiology in 6 (11.1%) patients with pathogenic/likely pathogenic causative variants. Three variants in MOCOS and one in ATP7B were pathogenic; likely pathogenic variants included MOCOS (n = 2), AGXT, and SLC7A9 (n = 1, each). Causality was not attributed to two SLC34A1 likely pathogenic variants, due to lack of matching phenotype and dominant family history. Compared to controls, allele frequency of the polymorphism TRPV5 rs4252402 was significantly higher in familial stone disease (allele frequency 0.47 versus 0.53; OR 3.2, p = 0.0001). CONCLUSION The chief metabolic abnormalities were hypercalciuria and hyperoxaluria. A monogenic etiology was identified in 11% with pathogenic or likely pathogenic variants using a gene panel for nephrolithiasis. Heterozygous missense variants in the sodium-phosphate cotransporter SLC34A1 were common and required evaluation for attributing pathogenicity. Rare polymorphisms in TRPV5 might increase the risk of familial stones. These findings suggest that a combination of metabolic and genetic evaluation is useful for determining the etiology of nephrolithiasis.
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Affiliation(s)
- Anita Mandal
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | | | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India.
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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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Sultan S, Aba Umer S, Ahmed B, Naqvi SAA, Rizvi SAH. Update on Surgical Management of Pediatric Urolithiasis. Front Pediatr 2019; 7:252. [PMID: 31334207 PMCID: PMC6616131 DOI: 10.3389/fped.2019.00252] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.
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Affiliation(s)
- Sajid Sultan
- Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Gouru VR, Pogula VR, Vaddi SP, Manne V, Byram R, Kadiyala LS. Metabolic evaluation of children with urolithiasis. Urol Ann 2018; 10:94-99. [PMID: 29416283 PMCID: PMC5791466 DOI: 10.4103/ua.ua_98_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study is to identify the prevalence of metabolic abnormalities in children with urolithiasis. Materials and Methods: This is a prospective study; all children below 15 years who are found to have urolithiasis were prospectively evaluated with relevant history, clinical examination, and urine and serum testing. Metabolic workup includes complete urine examination, urine culture and sensitivity, and 24-h urinary analysis (lithorisk profile). Results: A total of 55 patients are included in the study. Forty-two are boys and 13 are girls aged between from 8 months to 15 years. Thirty-three patients underwent stone analysis, primary composition of calcium oxalate stones in 19 (58%), ammonium urate in 4, dahlite in 3 and uric acid in 3, silicon oxide in 2, and struvite in 2 cases. Lithorisk profile was performed in 40 cases (72.7%). The pH range is 5.6–6.2. We noted hypercalciuria in 20 patients (50%), hyperuricosuria in 23 (57.5%), hyperoxaluria in 20 (50%), hypernatriuria in 26 (65%), hypocitraturia in 9 (23%), and hypomagnesuria in 3 (7.5%). Urine calcium-to-creatinine ratio >0.2 was found in 22 (55%) patients. Statistically significant association between hyperoxaluria and hyperuricosuria (P < 0.04, r = 0.32) and hypercalciuria and hyperuricosuria (P < 0.001, r = 0.51) found in this study. Hyperuricosuria is seen in 75% and 73% of patients with hypercalciuria and hyperoxaluria, respectively. Twenty-five children have both lithorisk profile and stone analysis. Hypercalciuria and hyperoxaluria were noted in 60% of calcium oxalate stone formers each. Elevated urinary calcium/creatinine ratio (>0.2) was seen in 73% of calcium oxalate stone formers. Conclusion: Because of high prevalence of metabolic risk factors and the significant risk of lifelong recurrence, all children with urolithiasis need complete evaluation with metabolic workup.
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Affiliation(s)
- Vijayabhaskar Reddy Gouru
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Vedamurthy Reddy Pogula
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Surya Prakash Vaddi
- Department of Urology and Renal Transplantation, Virinchi Hospitals, Hyderabad, Telangana, India
| | - Venu Manne
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Ranadheer Byram
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Lalith Sagar Kadiyala
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
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Zafar MN, Ayub S, Tanwri H, Naqvi SAA, Rizvi SAH. Composition of urinary calculi in infants: a report from an endemic country. Urolithiasis 2017; 46:445-452. [PMID: 29101428 DOI: 10.1007/s00240-017-1010-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022]
Abstract
Pediatric urolithiasis remains endemic in low-resource countries where infants constitute 17-40% of all children with urolithiasis. This study reports socio-economic factors, medical history and chemical composition of urinary stones in 976 infants of up to 2 years of age. Between 1992 and 2016, 976 infants presented to our institute with 1038 stones. Chemical composition of stones was analyzed by Fourier transformation infrared spectroscopy (FTIR). The mean age of infants was 19.5 ± 5.74 months with a M:F ratio of 5.5:1. Half (50%) of the infants were rural dwellers, 90% belonged to low socio-economic class and 70% were malnourished. A history of chronic diarrhoea was reported in 13% and urinary tract infections in 5%. The anatomic location was bladder in 487 (46.9%), kidney in 246 (23.6%), ureter in 142 (13.6%), urethra in 2 (0.2%) and 161 (15.5%) were passed spontaneously. Overall frequency of compounds in stones showed ammonium acid urate (AAU) in 772 (74.37%), calcium oxalate (CaOx) in 410 (39.5%). Uric acid (UA) in 119 (11.46%), calcium phosphate apatite (CaP) in 96 (9.25%), magnesium ammonium phosphate (Struvite) in 45 (4.34%), cystine in 12 (1.16%) and xanthine in 40 (3.85%). Frequency of compounds was similar in genders. Infants of age 0-6 months had higher frequency of UA (28%), CaOx (50%) and low AAU (61%) as compared to 11, 39 and 75%, respectively, in 7-24 months (p < 0.049) (p < 0.002) (p < 0.001). Nucleus of stones showed pure AAU in 63 and 43% on the surface due to addition of CaOx, struvite and CaP. Our study has shown that AAU is a major component of stones in infants where the main risk factors are poverty, malnutrition, diarrheal diseases and dehydration.
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Affiliation(s)
- Mirza Naqi Zafar
- Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| | - Salma Ayub
- Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Hafsa Tanwri
- Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Syed Ali Anwar Naqvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Endemic bladder calculi in children. Pediatr Nephrol 2017; 32:1489-1499. [PMID: 27848095 DOI: 10.1007/s00467-016-3492-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 02/23/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
Abstract
Urinary calculi are being recognized more frequently in children and the urinary bladder is the most common site for stone formation in the lower urinary tract. Bladder calculi are grouped into three basic categories: primary idiopathic/endemic, secondary, and migrant. The incidence of vesical calculi has declined significantly in the last 70 years in developed nations owing to improvements in nutrition and socioeconomic conditions, but it is still high in developing nations. Primary idiopathic/endemic bladder calculi typically occur in children, in the absence of urinary tract infection (UTI), urinary stasis, or foreign body, and diet lacking in animal proteins is the major contributor factor. Comprehensive preventive and treatment strategies are critical for improving the quality of life of diseased children, in addition to helping to eradicate, or at least decrease, the incidence of endemic bladder calculi in developing nations.
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Talati JJ, Hulton SA, Garrelfs SF, Aziz W, Rao S, Memon A, Nazir Z, Biyabani R, Qazi S, Azam I, Khan AH, Ahmed J, Jafri L, Zeeshan M. Primary hyperoxaluria in populations of Pakistan origin: results from a literature review and two major registries. Urolithiasis 2017; 46:187-195. [DOI: 10.1007/s00240-017-0996-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/18/2017] [Indexed: 11/30/2022]
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Rizvi SAH, Hussain M, Askari SH, Hashmi A, Lal M, Zafar MN. Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients. BJU Int 2017; 120:702-709. [PMID: 28303631 DOI: 10.1111/bju.13848] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18 years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup. PATIENTS AND METHODS We retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients' age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997-2005 and 2006-2014, to study the differences. RESULTS Of the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast® master in 524 (15.4%). In the majority of patients (97.4%) a 18-22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4 L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate. CONCLUSIONS This is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.
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Affiliation(s)
- Syed Adibul Hasan Rizvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
| | - Manzoor Hussain
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
| | - Syed Hassan Askari
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
| | - Altaf Hashmi
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
| | - Murli Lal
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
| | - Mirza Naqi Zafar
- Department of Pathology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan
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Clinical Signs, Causes, and Risk Factors of Pediatric Kidney Stone Disease: A Hospital-Based Case-Control Study. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.41668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rizvi SAH, Sultan S, Zafar MN, Ahmed B, Aba Umer S, Naqvi SA. Paediatric urolithiasis in emerging economies. Int J Surg 2016; 36:705-712. [DOI: 10.1016/j.ijsu.2016.11.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 01/10/2023]
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Imran K, Zafar MN, Ozair U, Khan S, Rizvi SAH. Metabolic risk factors in pediatric stone formers: a report from an emerging economy. Urolithiasis 2016; 45:379-386. [PMID: 27744630 DOI: 10.1007/s00240-016-0922-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Abstract
The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15 years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15 years. Patients were evaluated for demographics, blood and 24 h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.
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Affiliation(s)
- Kiran Imran
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| | - Mirza Naqi Zafar
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Uzma Ozair
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sadia Khan
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Syed Adibul Hasan Rizvi
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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End Stage Renal Disease: Seroprevalence of Hepatitises B and C along with Associated Aetiology and Risk Factors in Children. J Trop Med 2015; 2015:936094. [PMID: 26346273 PMCID: PMC4541010 DOI: 10.1155/2015/936094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 07/25/2015] [Indexed: 12/17/2022] Open
Abstract
Background. End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported. Methods. This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient. Results. 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 years. Sixty percent (n = 262) of the children were boys. The most common etiology of ESRD was kidney stones (n = 44, 29.3%). HBV was positive in 11 children (2.5%) while HCV was positive in 13 (2.9%). Conclusion. This study asserts the need for carrying out further work to confirm these findings and expand our recommendations. It is imperative to reliably determine the burden of HBV and HCV disease and to determine the aetiology of their spread especially in children with ESRD.
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Wumaner A, Keremu A, Wumaier D, Wang Q. High incidence of urinary stones in Uyghur children may be related to local environmental factors. J Pediatr Urol 2014; 10:289-93. [PMID: 24095687 DOI: 10.1016/j.jpurol.2013.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/01/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the causes of urolithiasis in Uyghur children from Xinjiang. PATIENTS AND METHODS We retrospectively evaluated the clinical features and characteristics of urinary stone composition of 220 Uyghur pediatric patients with urolithiasis between March 2009 and June 2011. The data were compared with that of 100 Uyghur children without urolithiasis who visited the Child Care Clinic for regular health check-ups. The stones were collected by endoscopy or open surgery, and analyzed using infrared spectroscopy. RESULTS The mean age of the 220 Uyghur children was 7.48 ± 4.73 years (range, 0.8-17.0 years). The overall sex ratio (male:female) was 2.23:1. The predominant pure stone was ammonium urate (58.9%), whereas the predominant mixed stone was calcium oxalate mixture (91.1%). Uric acid stones comprised 54% of all stones. Urinary tract infections were observed in 42.3% and 4.0% of the patient and control groups, respectively. The mean urinary pH values were 5.77 ± 0.67 and 6.42 ± 0.67, respectively (p < 0.001). pH values were <5.5 in 52.7% and 6% of the patient and control groups, respectively. On 24-h urine analysis, we found metabolic disturbances in these patients: hypercalciuria in 6.8% cases, hyperphosphaturia in 16.8% cases, hyperuricosuria in 21.4% cases, and hypomagnesiuria in 34.1% cases. CONCLUSIONS Urolithiasis in Uyghur children may be primarily related to local environmental factors.
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Affiliation(s)
- Aikebaier Wumaner
- Xinjiang Clinic College, Anhui Medical University, No. 84 Meishan Road, Chushan Area, Hefei 200135, China
| | - Aziguli Keremu
- Department of Clinical Laboratory, People's Hospital of Xinjiang Uyghur Autonomous Region, No. 91 Tianchi Roud, Tianshan Area, Urumqi 830001, Xinjiang, China
| | - Dilixiati Wumaier
- Department of Urology, First People's Hospital of Kashi, No. 66 Yingbin Road, Kashi 844000, Xinjiang, China
| | - Qing Wang
- Xinjiang Clinic College, Anhui Medical University, No. 84 Meishan Road, Chushan Area, Hefei 200135, China.
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Mohammadjafari H, Barzin M, Salehifar E, Khademi Kord M, Aalaee A, Mohammadjafari R. Etiologic and epidemiologic pattern of urolithiasis in north iran;review of 10-year findings. IRANIAN JOURNAL OF PEDIATRICS 2014; 24:69-74. [PMID: 25793048 PMCID: PMC4359607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/27/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine epidemiologic and metabolic characteristics of renal stone in the northern Iran. METHODS We prospectively analyzed demographic, clinical and metabolic findings in children less than 16 years old with renal stone revealed by ultrasonography from September 2003 to May 2012. Evaluations included serum and urine measurement of main elements predisposing patients to stone formation. Findings : 271 children (160 males) aged 2 months to 16-years (mean 30 months) were evaluated. 91 (33.6%) had a positive family history, abdominal discomfort (18.8%), UTI (11.8%) and hematuria (11.4%) were main presenting features. 45 children were diagnosed accidentally without any specific compliant. Nearly all (99%) stones lay in kidney., 35.1% had metabolic, 10% infective and 4.1% obstructive trends, 110 children had no definable etiology. Hypercalciuria (25.5%) hyperoxaluria (18.4%) and hypocitraturia (18.1%) were more frequent than uricosuria (8.5%) and cystinuria (3.1%) CONCLUSION Metabolic derangement plays significant role in stone formation in our area. Patients should be carefully evaluated considering this point of view.
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Affiliation(s)
- Hamid Mohammadjafari
- Department of Pediatrics, Cellular and Molecular Research Center, Faculty of Medicine,Corresponding Author: Address: Department of Pediatrics, Mazandaran University of medical sciences, Sari, Iran
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Sultan S. Evolution of pediatric urology at sindh institute of urology and transplantation. Front Pediatr 2014; 2:88. [PMID: 25250303 PMCID: PMC4157550 DOI: 10.3389/fped.2014.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/01/2014] [Indexed: 01/10/2023] Open
Abstract
Sindh Institute of Urology and Transplantation was started in 1972 as an eight bedded department of genitourinary surgery in a government hospital by its pioneer and present director Syed Adib ul Hassan Rizvi. Responding to the socioeconomic dynamics and the needs of the patient population the facility grew into the largest tertiary care Urology, Nephrology, and Transplant center of south Asia. One of the salient components has been the evolution of the Department of Pediatric Urology, which in itself has shown a tremendous growth into an internationally recognized center for pediatric urology services taking care of all aspects including center of excellence for pediatric stone disease. The guiding mission of this institute remains to provide free medical services at zero cost without any discrimination to all who come to its doorstep and matching with high standard of care without compromising their dignity and self-respect. This institute highlights the fact that lack of resources is no excuse and is a role model for developing countries, where national and international support, motivation, and cooperation can offer more advanced and better quality medical services to our children.
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Affiliation(s)
- Sajid Sultan
- Philip G. Ransley Department of Paediatric Urology, Sindh Institute of Urology and Transplantation (SIUT) , Karachi , Pakistan
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Abhishek, Kumar J, Mandhani A, Srivastava A, Kapoor R, Ansari MS. Pediatric urolithiasis: experience from a tertiary referral center. J Pediatr Urol 2013; 9:825-30. [PMID: 23348148 DOI: 10.1016/j.jpurol.2012.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 11/02/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pediatric urolithiasis can cause significant morbidity and damage to the kidney, or even renal failure. We review our experience of the management of urolithiasis in pediatric patients at a tertiary referral center. PATIENTS AND METHODS We reviewed medical records of all children with urolithiasis who were diagnosed and managed at our center from August 2003 to October 2011. Management was planned according to stone burden and location. We noted and statistically analysed data about age, sex, stone burden, clinical features, management, metabolic abnormalities and recurrence. RESULTS There were 325 children with 378 stone sites. Age range was 3-17 (mean 8) years. The male to female ratio was 3:1. Most common presentation was abdominal pain in 257 children (79%), and the most common stone site was kidney in 215 (57%). Twenty-four (7%) children (stone burden ≤3 mm) were managed conservatively, while the rest received some form of intervention. Metabolic workup could be done in 154 (47%) children. A metabolic abnormality was seen in 67 (43%) children, normocalcemic hypercalciuria being the most common. Recurrence of urolithiasis was seen in 78 (24%) children after a mean follow-up of 3.2 (1-6) years, and was more common in those who had a metabolic abnormality or in whom small residual fragments were left in situ. CONCLUSIONS Availability of smaller instruments has led to safer use of percutaneous endoscopy and ureteroscopy in children, with results comparable to those in adults and an acceptable complication rate. The presence of a metabolic abnormality is quite common and is a cause of recurrence.
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Affiliation(s)
- Abhishek
- Department of Urology and Renal transplantation, Sanjay Gandhi Postgraduate Institute of Medical Science, Raebreali Road, Lucknow 226014, U.P, India
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Memon A, Anwar K, Orakzai N, Ather MH, Biyabani SR, Nasir AR, Paryani JP, Ghani F, Siddiqui KM, Abbas F, Bangash K, Ali L, Aziz W, Talati JJ. Epidemiology of Stone Disease in Pakistan. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rizvi SA, Sultan S, Ijaz H, Mirza ZN, Ahmed B, Saulat S, Umar SA, Naqvi SA. Open surgical management of pediatric urolithiasis: A developing country perspective. Indian J Urol 2011; 26:573-6. [PMID: 21369393 PMCID: PMC3034069 DOI: 10.4103/0970-1591.74464] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives To describe decision factors and outcome of open surgical procedures in the management of children with stone. Materials and Methods Between January 2004 and December 2008, 3969 surgical procedures were performed in 3053 children with stone disease. Procedures employed included minimally invasive techniques shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), perurethral cystolithotripsy (PUCL), percutaneous cystolithotripsy (PCCL), and open surgery. From sociomedical records demographics, clinical history, operative procedures, complications, and outcome were recorded for all patients. Results Of 3969 surgeries, 2794 (70%) were minimally invasive surgery (MIS) techniques to include SWL 19%, PCNL 16%, URS 18.9%, and PUCL+PCCL 16% and 1175 (30%) were open surgeries. The main factors necessitating open surgery were large stone burden 37%, anatomical abnormalities 16%, stones with renal failure 34%, gross hydronephrosis with thin cortex 58%, urinary tract infection (UTI) 25%, and failed MIS 18%. Nearly 50% of the surgeries were necessitated by economic constraints and long distance from center where one-time treatment was preferred by the patient. Stone-free rates by open surgeries were pyelolithotomy 91%, ureterolithotomy 100%, and cystolithotomy 100% with complication rate of upto 3%. Conclusions In developing countries, large stone burden, neglected stones with renal failure, paucity of urological facilities, residence of poor patients away from tertiary centers necessitate open surgical procedures as the therapy of choice in about 1/3rd of the patients. Open surgery provides comparable success rates to MIS although the burden and nature of disease is more complex. The scope of open surgery will remain much wide for a large population for considered time in developing countries.
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Affiliation(s)
- Syed A Rizvi
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
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