Diagnostic examination of the child with urolithiasis or nephrocalcinosis

Abstract

Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis.

Urinary level of interleukin-1alpha and interleukin-6 in patients underwent extracorporeal shock wave lithotripsy

“…ESWL candidates were those with urinary stones (5 to 20 mm) diagnosed by history, physical examination, laboratory and imaging tests. All of them were included in our study (17,18). The exclusion criteria was essential hypertension, active bleeding disorders, serum creatinine above 3 mg/dL, urinary obstruction distal to the stone, urinary tract abnormalities (horseshoe kidney, displaced kidney, and extra-kidney), the history of colicky or renal lodge pain or taking analgesics or any other antiinflammatory or immunosuppressant in previous week and existence of any infection (21)(22)(23)(24)(25).…”

Pediatric Nephrolithiasis: Trend, Evaluation and Management: A Systematic Review

“…This disorder has two types PH-1 and PH-2 (7,(23)(24)(25). Tubular disorders such as cystinuria increased the risk of stone formation, which accounted for 3% of renal stones (26). Some systemic diseases such as CF and inflammatory bowel diseases (IBD) may be associated with nephrolithiasis.…”

Urinary excretion of calcium, magnesium, phosphate, citrate, oxalate, and uric acid by healthy schoolchildren using a 12-h collection protocol

“…All children with a first kidney stone or the diagnosis of nephrocalcinosis should be screened for metabolic reasons for stone disease in order to start preventive measures as soon as possible [1,2]. However, what is the best way to collect adequate urine sample(s) first to gain normal age-related values, and secondly to obtain adequate diagnostic information?…”

“…Although most of our pediatric patients may have a metabolic basis of kidney stone disease [1,2], we still have to also search for other factors leading to urolithiasis or nephrocalcinosis [5]. In this respect, it is truly important to take into consideration that the urine collected overnight may depict metabolic/genetic diseases, but will not give evidence for environmental factors influencing urinary excretion parameters, here most obviously nutrition.…”

“…Three 24-h urine samples are collected, one under "normal" diet, one under a lowoxalate diet, and one with a high-oxalate intake (spinach, rhubarb) and all stone risk factors are analyzed [2,9]. In addition, a urinary pH profile is done depending on the first urine results (e.g., low citrate excretion) or stone analysis (e.g., phosphate stones).…”