American and Brazilian Children With Primary Urolithiasis

Abstract

Objectives. Considering the differences in location, socioeconomic background, and cultural background, the aim of this study was to try to identify possible factors associated with the increased incidence of urolithiasis by comparing American and Brazilian children with stones. Methods. Data of 222 American and 190 Brazilian children with urolithiasis were reviewed including age, gender, body mass index, imaging technique used (ultrasound and computed tomography), and 24-hour urine volume and chemistries. Results. There were no differences between age and gender at diagnosis. Brazilian children were leaner but in no population did obesity rate exceed that of the general population. Ultrasound was most commonly used to diagnose stones, even more so in Brazilians. Decreased urine flow was more common among Americans (P = .004), hypercalciuria among Brazilians (P = .001), and elevated Ca/citrate ratio among Americans (P = .009). There were no differences between the groups in the frequency of hypocitraturia, hyperuricosuria, absorptive hyperoxaluria, and cystinuria. Conclusions. Despite some differences between the populations, the leading causes of urolithiasis among both were “oliguria,” hypercalciuria, and high Ca/citrate ratio. In neither country was obesity the reason for the increase in incidence of urolithiasis, nor was the use of computed tomography. The similarities between the 2 populations call for combining efforts in addressing the leading causes of pediatric urolithiasis.

Association between dietary pattern and metabolic disorders in children and adolescents with urolithiasis

“…Most patients were male, in agreement with the findings of other investigations 17 ( Table 2 ). While it is historically more frequent in this sex, 1 the incidence of UL among the female population is already higher in some studies.…”

“…Conversely, other studies showed a variation of 11.3–11.8 years old, a higher average than that observed in the present study. 18 , 20 This lower age at the diagnosis of the Brazilian patients was already verified by Penido et al 17 in a cohort study with American and Brazilian children and adolescents with UL. The authors showed that the Brazilian patients are usually younger at the diagnosis.…”

“…While it is historically more frequent in this sex, 1 the incidence of UL among the female population is already higher in some studies. 1 , 2 , 18 , 19 Nonetheless, American data showed a uniform distribution between the genders, 17 , 18 , 20 suggesting there is no causal relationship between them and the occurrence of UL.…”

“…The high rates of hypocitraturia and hypercalciuria were expected, given that it was also the finding of several authors. 17 , 18 , 23 , 24 Penido et al 17 hypothesized that, although hypercalciuria is very relevant in UL and is frequently the most prevalent MD, it cannot always individually justify the calculi formation, unless associated with a low level of citrate. 25 …”

Perfil Clínico-Epidemiológico De 106 Pacientes Pediátricos Portadores De Urolitíase No Rio De Janeiro

“…Kovacevic et al 23 pointed out to the importance of the association between previous urinary infection and hypocitraturia, and this result was confirmed in this study. In the study by Penido, 24 24.3% of the cases showed no metabolic change, only the reduction in urine volume (normal value: ≥1 ­mL/­kg/h). These findings suggest that the dietary investigation and the urinary metabolic analysis are essential to the follow-up of these patients.…”