Multidimensional Analysis of Urinary Stone Diseases in Pediatric Patients

Objectives: Urinary tract stones are less common in children than in adults. Determining the etiology is the most important step to achieve successful treatment and prevent future recurrence. The aim of this study was to investigate the clinical characteristics and possible risk factors for urinary stone disease in pediatric patients.
Methods: The data of 126 patients with urinary stone disease who were treated in a pediatric nephrology clinic between 2000 and 2014 were analyzed retrospectively. A total 126 patients were enrolled in the study: 70 (55%) male and 56 (45%) female patients were included. The complaints, age of diagnosis, family histories, and stone location were examined. Direct urine microscopic examination, complete urinalysis, and urine culture were performed for all of the patients. Calcium, uric acid, oxalate, citrate, magnesium, and cystine levels were measured in urine collected in a 24-hour period. Serum electrolyte, blood urea nitrogen, creatinine, calcium, phosphorus, uric acid, and albumin levels were measured. Urinary ultrasound was performed. Stone analysis was conducted using the X-ray diffraction method. The mean age of the patients was 55 months (range: 1-162 months) at presentation.
Results: In all, 34% of the patients had a family history of urinary stone disease. The rate of previous urinary tract infection was 26%. It was determined that 34% of the patients had been taking vitamin D and 5% had been taking a high dose. Metabolic risk factors determined were: hypercalciuria in 41%, hypocitraturia in 30%, hyperoxaluria in 14%, hyperuricosuria in 10%, and cystinuria in 5%. Among the group, 81% of the patients had kidney stones, 6.5% had ureter stones, and 2.5% had bladder stones. Furthermore, it was determined that 45% of the stones were composed of calcium oxalate, 35% had calcium phosphate stones, 14.2% had uric acid stones, and 13.3% had cystine stones. In 52% of the cases, extracorporeal shock wave lithotripsy was performed, and 71% underwent surgical treatment.
Conclusion: Metabolic evaluation and stone analysis should be performed to prevent future recurrences in children with urinary stone disease and lifelong follow-up should be emphasized.

Çocuk Üriner Sistem Taþ hastalýklarýnýn Çok Yönlü Analizi

Üriner sistem taþlarý çocuklarda eriþkinlerde olduðundan daha seyrek görülür. Ürolitiazis olgularýnda etiyolojiyi belirlemek, tedavide baþarýyý saðlamak ve rekürrensi önlemek açýsýndan oldukça önemlidir. Bu çalýþmada pediatrik üriner sistem taþ hastalýklarýnýn klinik özellikleri ve olasý risk faktörlerinin araþtýrýlmasý amaçlandý.
Çocuk Nefroloji Polikliniðinde 2000-2014 yýllarý arasýnda üriner sistem taþ hastalýðý tanýsýyla takip edilen 126 hastanýn verileri retrospektif olarak incelendi. Olgularýn baþvuru yakýnmalarý, taný yaþlarý, aile öyküleri, taþýn yerleþim yerleri belirlendi. Hastalarýn tümünde direkt idrar mikroskopik bakýsý, tam idrar tetkiki ve idrar kültürü yapýldý, 24 saatlik idrar toplanabilen hastalarda bir günlük idrarda kalsiyum, ürik asit, okzalat, sitrat, magnezyum ve sistin düzeyleri ölçüldü, serum elektrolit, kan üre azotu, kreatinin, kalsiyum, fosfor, ürik asit, albümin ölçümleri, üriner USG ve taþ analizi (X ýþýný ile difraksiyon yöntemiyle gerçekleþtirildi)
14 yýllýk takipte kayýtlarý tam olan 126 olgu çalýþmaya katýldý. Bu hastalarýn 70’i (%55) erkek 56’sý (%45) kýz idi. Hastalarýn baþvuru yaþý 55 aydý (1-162). Hastalarýn %34’ünde ailede taþ öyküsü vardý.Geçirilmiþ idrar yolu enfeksiyonu (ÝYE) öyküsü oraný %26 idi. Olgularýn %34’ünde D vitamini kullanýmý vardý ve %5’inde yüksek doz mevcuttu. Metabolik risk faktörü oranlarý,%41 hiperkalsiüri, %30 hipositratüri, %14 hiperoksalüri, %10 hiperürikozüri, %5 sistinüri olarak belirlenmiþti. Taþýn lokalizasyonu hastalarýn %81 inde böbreklerde, %16,5’unda üreterde, %2,5’ýnda mesanede görüldü. Taþ analizinde; hastalarýn %45’inde kalsiyum oksalat, %35’inde kalsiyum fosfat, %14,2’sinde ürik asit, %13,3’ünde sistin içeriði tespit edilmiþti.Uygulanan tedaviler; %52 oranýnda ESWL, %71 oranýnda cerrahi giriþimdi.
Üriner sistem taþ hastalýðý olan çocuklarda rekürrensleri önlemek için metabolik deðerlendirme ve taþ analizi yapýlmalý, ömür boyu takip gereði vurgulanmalýdýr.