A Study of the Etiology of Idiopathic Calcium Urolithiasis in Children: Hypocitruria Is the Most Important Risk Factor

Tekın, Ali; Tekgül, Serdar; Atsü, Necmettin; Şahin, Ahmet; Özen, Haluk; Bakkaloḡlu, M.

doi:10.1097/00005392-200007000-00053

Cited by 15 publications

(25 citation statements)

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“…Together with hypocitruria, hypercalciuria is an important risk factor in our region, which is in agreement with the data reported from South Turkey [31] and West Turkey [26,32,33]. Based on the results from a study carried out in Central Turkey, the authors suggested that hypocitruria is the most important risk factor for idiopathic calcium stones [6], whereas in another city of the same region, hypercalciuria and hyperuricosuria were the most common metabolic abnormalities [34]. Thus an underlying metabolic risk factor has been identified in many cases of urolithiasis, justifying the detailed metabolic evaluation of each child who has once had urinary stone disease.…”

Section: Discussionsupporting

confidence: 91%

“…Although pediatric urolithiasis is rare in western countries, it remains a common health problem in some parts of the world, such as Turkey [6]. The wide geographic variations in the incidence of lithiasis in childhood appear to be related to climatic, dietary and socio-economic factors [7].…”

Section: Discussionmentioning

confidence: 99%

“…Studies carried out on Turkish children found that urinary stones were the etiological factor in 8% of children with chronic renal failure [4,5]. Although the frequency of childhood urolithiasis is steadily decreasing in developing countries, it remains a common health problem in some parts of the world, as in Turkey [6]. One epidemiological study reported that the incidence of urolithiasis among asymptomatic Turkish primary school children was as high as 1% [3].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and metabolic features of urolithiasis and microlithiasis in children

et al. 2009

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We evaluated the clinical, radiological and metabolic features of 162 children with urolithiasis or microlithiasis who had been referred to our pediatric nephrology clinics between 1998 and 2008 with suspected urolithiasis. The medical histories of these children (78 girls, 84 boys), who ranged in age from 2 months to 16 years (mean age 5.59 +/- 0.35 years), were reviewed retrospectively for clinical and metabolic features of urinary tract calculi. Urinary tract infections (UTI) were present in 45.9% of the cases. The most common presenting symptoms were flank pain or restlessness (25.3%) and hematuria (21.6%), followed by UTI (16%), whereas 23.5% of the cases were detected incidentally during evaluation for other medical conditions. Other symptoms at presentation included dysuria, passing stones, penile edema, enuresis, vomiting and anorexia. Urine analysis revealed metabolic abnormalities in 87% of the cases, including hypercalciuria (33.8%), hypocitraturia (33.1%), hyperoxaluria (26.5%), hyperuricosuria (25.4%), hypocitraturia + hypercalciuria (21.1%), hyperphosphaturia (20.8%) and cystinuria (5.7%). Almost 50% of the patients had a positive family history for urolithiasis. The most frequently involved site was in the kidneys (86%). Ureters and bladder were involved in 12 and 2% of the cases, respectively. A family history of urolithiasis, presenting symptoms and underlying metabolic abnormalities were similar for microlithiasis and the patients with larger stones. However, in our study population, microlithiasis was mainly a disease of young infants, with a greater chance for remission and often not associated with structural changes. The presenting symptoms of urolithiasis show a wide spectrum, so that a high index of suspicion is important for early detection. A metabolic abnormality can be identified in 87% of cases of urolithiasis. Detection of microlithiasis may explain a number of symptoms, thus reducing invasive diagnostic procedures and allowing early recognition of metabolic abnormalities. These results draw attention to the importance of screening for UTIs in patients with urolithiasis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and metabolic features of urolithiasis and microlithiasis in children

et al. 2009

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“…In a recent series from Turkey, Tefekli et al [19] found that hypocitraturia was the most prevalent metabolic risk factor in children with lithiasis (60.6 %). In another well-designed study by Tekin et al [20], also from Turkey, it was shown that children with calcium oxalate stones excreted less citrate and more oxalate than the controls. Although the relatively high frequency of hypocitraturia in the Turkish series may be related to local dietary habits or other regional causes, in another recent series from New York, VanDervoort et al [5] also noted that hypocitraturia was the most common metabolic abnormality found; it was present in 52% of the children studied between 2003-2005.…”

Section: Discussionmentioning

confidence: 94%

Metabolic risk factors in children with kidney stone disease

et al. 2008

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The evaluation of metabolic risk factor in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of preexisting calculi. In this retrospective study, we evaluated the metabolic risk factors and clinical and family histories of 90 children with kidney stone disease who had been referred to our institution and subjected to clinical tests using a standardized protocol. The mean age of our pediatric patients was 10.7 years, and the male:female ratio was 1.14:1.0. Biochemical abnormalities were found in 84.4% of all cases. A single urine metabolic risk factor was present in 52.2% (n = 47) of the patients, and multiple risk factors were present in the remaining 31.1% (n = 28). Idiopathic hypercalciuria (alone or in combination) and hypocitraturia (alone or in combination) were the most frequent risk factors identified in 40 and 37.8% of these patients, respectively. Renal colic or unspecified abdominal pain were the most frequent forms of presentation (76.9%), with 97.5% of stones located in the upper urinary tract. In most patients, stone disease was confirmed by renal ultrasonography (77%). A positive family history in first-degree and second-degree relatives was found in 46.2 and 32.5% of the cases, respectively. We conclude that specific urine metabolic risk factors are found in most children with kidney stones and that hypocitraturia is as frequent as hypercalciuria. Very often there is a positive family history of renal stone disease in first- and second-degree relatives.

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“…UL is also an important problem in Turkey [29,30,31]. In our study, we compared XRD and BSM for the assessment of urinary stones.…”

Section: Discussionmentioning

confidence: 99%

Determination of urinary calculi by binocular stereoscopic microscopy

Nayır

2002

Pediatr Nephrol

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Because of the inadequacies of chemical methods for identifying urinary calculi, mineralogical methods have been developed, but these methods are sometimes time consuming and expensive. The aim of the study was to evaluate urinary calculi with binocular stereoscopic microscopy (BSM), X-ray diffraction (XRD), scanning electron microscopy (SEM), and biochemical methods and to determine the specificity of BSM. A total of 30 pediatric patients with urinary calculi (17 girls and 13 boys), from 6 months to 19 years of age, were included in the study. The calculi obtained were evaluated with a Novex-AP 8 BSM, a Shimadzu 6000 XRD device, a Jeol JXA 733 SEM, and a biochemical kit from Merck. In 2 cases BSM rapidly determined that the material was not from the urinary system. Except for 2 cases, BSM results were identical to the results obtained by XRD. In 2 non-identifiable cases, the samples were struvite with an amorphous structure. The sensitivity of BSM was 93%. The small size of calculi did not permit biochemical analysis in 4 cases. In another group of 4 cases, the results of biochemical analysis did not agree with the XRD. In 7 cases, calcium phosphate was found by biochemical assay, although it was not confirmed by XRD. The sensitivity of biochemical analysis was 58%. BSM is more reliable than biochemical methods. BSM can be used for a rapid, reliable evaluation of the urinary calculi. It gives additional information about the nidus, the crystalline structure, and the order of deposition of components. The clinician can perform this investigation himself, obtaining very useful information about stone formation that allows an immediate start of medical treatment, decreasing recurrences.

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A Study of the Etiology of Idiopathic Calcium Urolithiasis in Children: Hypocitruria Is the Most Important Risk Factor

Cited by 15 publications

References 15 publications

Clinical and metabolic features of urolithiasis and microlithiasis in children

Clinical and metabolic features of urolithiasis and microlithiasis in children

Metabolic risk factors in children with kidney stone disease

Determination of urinary calculi by binocular stereoscopic microscopy

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