Üriner sistem taþý olan çocuklarda metabolik bozukluklar ve cinsiyetin etkisi

Amaç: Üriner sistemde taþ varlýðý; yaþ, cinsiyet, diyet, iklim ve genetik nedenlerle iliþkilidir. Enfeksiyonlar, anatomik ve metabolik bozukluklar taþ oluþuma eðilim yaratan nedenlerdir. Bu çalýþmada üriner sistem taþý olan çocuklarda epidemiyolojik ve metabolik faktörlerin deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Retrospektif olan bu çalýþmada, ürolitiazis, mikrolitiazis ve ürolitiazis hikayesi olan 0-18 yaþ aralýðýndaki 89 (46 kýz) hastanýn dosyasý geriye dönük þekilde incelendi. Güncel yaþ, cinsiyet, taný yaþý, baþvuru semptomlarý, ailede taþ hikayesi, fizik muayene bulgularý, kullandýklarý ilaçlar, laboratuvar tetkikleri (kan üre nitrojeni, serum kreatinin, elektrolit, kan gazlarý; idrarda kalsiyum, ürik asit, okzalat, sistin, sitrat, magnezyum ve kreatinin düzeyleri deðerlendirildi) ve radyolojik bulgular kaydedildi.
Bulgular: Yaþ ortalamasý 6.20±5.27 (minimum-maksimum, 0.2-18.2) yýl idi. Taþlar en sýk böbrekte yerleþmekteydi (n=52, %58.4). Yirmi iki hasta (%24.7) mikrolitiazis, 64 hasta (%71.9) ürolitiazis ve üç hasta (%3.4) ürolitiazis hikayesi olan grupta idi. Anatomik sorunlar %17.9 hastada saptandý. Tüm hastalarýn 31’inde (%34.8) idrar analizlerinde metabolik bozukluk saptandý. Yirmi altý (%29.2) hastada
tek metabolik bozukluk saptanýrken, birden fazla metabolik bozukluk beþ (%5.6) hastada tespit edildi. Kýzlarda metabolik bozukluk erkeklerden iki kat fazla idi (p=0.027). En sýk metabolik bozukluk hipositratüri (n=16, %17.9) ve sonrasýnda hiperokzalüri (n=8, %8.9), hiperkalsiüri (n=6, %6.7) ve hiperürikozüri (n=6, %6.7) olarak tespit edildi.
Sonuçlar: Üriner sistem taþý olan çocuklarda metabolik bozukluklar sýk saptandý. Hipositratüri en sýk saptanan bozukluklardan olup hasta yönetimi için kapsamlý deðerlendirme gereklidir. Kýz cinsiyet metabolik bozukluk için yatkýnlýk oluþturan bir faktör olarak kabul edilebilir.

Metabolic abnormalities in children with urinary stone disease and the influence of gender

Objective: Urinary stone disease is associated with age, gender, diet, climate, and genetic causes. Infections, anatomic and metabolic abnormalities can lead to stone formation. We aimed to evaluate epidemiologic and metabolic factors in children with urolithiasis.
Material and Methods: A total of 89 patients (46 girls), aged between 0 and 18 years with diagnosis of urolithiasis, microlithiasis and a history of urolithiasis were recruited in this retrospective study. Medical records were assessed for current age, gender, age at diagnosis, presenting symptoms, family history, physical findings, medications, results of laboratory tests (including blood urea nitrogen, serum creatinine, electrolytes, blood gases, urinalysis: urinary calcium, uric acid, oxalate, cystine, citrate, magnesium and creatinine levels) and radiological findings.
Results: The mean age was 6.20±5.27 (range, 0.2-18.2 years). Stones were mostly located in the kidneys (n=52, 58.4%). Microlithiasis, urolithiasis and urolithiasis history were defined in 22 (24.7%), 64 (71.9%), and 3 (3.4%) patients, respectively. Anatomic abnormalities were determined in 17.9% of the patients. Of all patients, 31 (34.8%) had metabolic abnormalities in their urinary analyses. While 26 patients (29.2%) had one metabolic abnormality, five (5.6%) patients had more than one. Metabolic abnormalities were two times more in girls than in boys (p=0.027). The most common metabolic disorder detected was hypocitraturia (n=16, 17.9%), followed by hyperoxaluria (n=8, 8.9%), hypercalciuria (n=6, 6.7%), and hyperuricosuria (n=6, 6.7%).
Conclusions: Metabolic abnormalities were detected frequently in children with urinary stone disease. Hypocitraturia was the most common metabolic abnormality. Detailed evaluation is needed to manage patients with urolithiasis. Female gender may be accepted as a predisposing factor for metabolic abnormality.