Diagnostic and treatment of urolithiasis in infants and children

Abstract

A series of 98 children with urolithiasis is analyzed especially with regard to some diagnostic and treatment problems of the disease. The results of the study of etiology, clinical features, associated diseases and metabolic disorders in this series are presented. Urinary stasis, urinary infection and metabolic disorders were found to be very frequent in children with kidney stones and are considered to be the main causes of stone formation.Urolithiasis has been shown to be a serious problem in Czechoslovakia. Mates and Kfi~ek [15] reported its occurrence in 1 per cent of population. The etiology of urolithiasis is so far not fully understood. Anomalies of the urinary tract with stasis of urine, metabolic disorders, long-term immobilization, urinary tract infections, alterations in the mechanism of protective colloids and vitamin A deficiency have been found to be the most frequent factors which promote the, formation of stones within the renal pelvis.Particularities of the infantile urolithiasis consist of the known geographic nonhomogeneity of its occurrence and of the greater number of anomalies of the excretory kidney pathways, by which urolithiasis is often accompanied. To be simultaneously solved, the anomalies require recognition before the operation of calculi.Also infantile urolithiasis is not uncommon in our country. Bedrna [2] observed it in 1.4 per cent of all lithiases, Kafka [11 ] in 20 per cent of infantile patients with urologic diseases. In Kukula's [12] group of 422 selected patients its incidence was 36 per cent in children. Elefant et al. [6] observed 160 children with urolithiasis, 17 of whom were younger than 1 year. Zvara et al. [22] selected 868 adults and 31 children with urolithiasis during 3 years. The number of children thus represented is 3.5 per cent. Kukula [12] elaborated the first extended study of the incidence of urinary stones in Bohemia. The first mention about infantile urolithiasis in Slovakia was found in Bdkay's [3 ] study, where the material from the past Austrian-Hungarian monarchy is summarized. In these older works bladder calculi are predominantly described. Kukula [12J included in his study only cystolithiases, Bdkay [3] found that of 1836 selected patients 1319 had cystolithiasis, 9 nephrolithiasis and 508 ureterolithiasis. Urology and Nephrology I, 1969

Urinary Stones in Children

“…Aslında bu durum idrar kristallerinin bir araya gelerek çökmesi ile oluşan kompleks bir süreçtir. Az sıvı alımı, ishal ve sıcak hava nedeniyle günlük çıkarılan idrar miktarının azlığı, hareketsizlik, idrar akımını bozan anatomik anormallikler, asidik idrar, idrar yolu enfeksiyonu (İYE), idrar sitrat miktarının düşüklüğü ve taş oluşturan iyonların (kalsiyum, okzalat, ürik asit, sistin) idrarda yüksek oranda bulunması gibi metabolik bozukluklar taş oluşumunu arttırmaktadır (6,7).…”

“…Kalsiyum, fosfor, okzalat, ürik asit ve sistin gibi solütlerin idrardaki konsantrasyonlarının artışı ve/veya sitrat, magnezyum ve pirofosfat gibi kristalizasyonun doğal inhibitörlerinin idrar konsantrasyonunun düşüklüğü üriner sistemde taş oluşumuna yol açar (5)(6)(7)(8).…”

Epidemiological and Clinical Significances of Urolithiasis in Childhood

“…Besides an overall analysis of our clinical material (8,9,19,20), we have, during the past 10 years, followed the problem of urolithiasis in a defined infant population of the city of Bratislava.…”