Metabolic Evaluation of Children with Urolithiasis: Are Adult References for Supersaturation Appropriate?

Battino, Benjamin S.; DeFoor, William; Coe, Fredric L.; Tackett, Leslie D.; Erhard, Michael; Wacksman, Jeffrey; Sheldon, Curtis A.; Minevich, Eugene

doi:10.1097/00005392-200212000-00075

Cited by 9 publications

(14 citation statements)

References 13 publications

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“…Recently, the addition of urine supersaturation measurement to the routine evaluation of children with urolithiasis has been advocated as a way to identify further children with a propensity to stone formation [6].…”

Section: Discussionmentioning

confidence: 99%

“…Cystine was reported by LithoLink as either positive or negative. Low urine volume was considered <1 cc/kg/h [6]. Z-scores were calculated for calcium oxalate supersaturations using published pediatric normative data [10].…”

Section: Methodsmentioning

confidence: 99%

“…Cystinuria is present in a small minority [1,3,4]. Other reports of pediatric urolithiasis demonstrate a higher proportion of children with hypercalciuria [5,6]. Some children with urolithiasis have no obvious predisposing factors, as demonstrated by standard metabolic or radiologic evaluations.…”

Section: Introductionmentioning

confidence: 99%

“…Supersaturation calculations for the major stone-forming salts accurately reflect kidney stone mineral composition, and supersaturation values are useful in predicting risk of stone recurrence. Measurement of urine supersaturation has become a focus in the clinical evaluation of adults with urolithiasis [7,8], but experience in children is limited [6].…”

Section: Introductionmentioning

confidence: 99%

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Role of urinary supersaturation in the evaluation of children with urolithiasis

et al. 2005

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Timed urine collections are a standard part of the evaluation for predisposition to stone formation in children with urolithiasis. Supersaturation is defined as the ratio of the concentration of dissolved salt to its solubility in urine. The purpose of the present study was to determine if adding supersaturation to the standard timed urine collection increased the ability to detect a metabolic predisposition to stone formation. Thirty-two children with urolithiasis had 24-hour urine measurements of calcium, oxalate, citrate, uric acid, and cystine (the "traditional" evaluation), as well as supersaturation for calcium oxalate, calcium phosphate, and uric acid, on the same urine sample. Nine (28%) of the 32 were hypercalciuric, 2 (6%) hyperoxaluric, and 4 (12%) hypocitraturic. In total, 14 (44%) had a metabolic predisposition that was detected by the traditional evaluation. Supersaturation was elevated in 18 (56%), including nine who did not have metabolic predisposition detected by traditional evaluation. Urine volume was low in 17 (53%) of 32 children, including eight of nine children with abnormal supersaturation but normal traditional evaluation. Only one child with normal traditional evaluation and normal urine volume had elevated supersaturation. These results show that the benefit of adding supersaturation to the traditional evaluation was largely negated by consideration of urine volume.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of urinary supersaturation in the evaluation of children with urolithiasis

et al. 2005

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“…3. A biological stage and a study of the cristalluria and a chemical analysis of the calculus [13][14][15][16].…”

Section: Etiological Investigationmentioning

confidence: 99%

Urolithiasis in infants

2007

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There are few publications about urolithiasis of the new born baby and infant (UNI). The UNI represents 20% of the pediatric urolithiasis. The etiologies in this age group are chiefly dominated by the urinary-tract infections and metabolic abnormalities. The purpose of this paper was to investigate the epidemiological and clinical characteristics of infant urolithiasis and to define the various treatment modalities adapted to this age group.

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Assessment of crystallization risk formulas in pediatric calcium stone-formers

2009

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The pathogenesis of calcium urolithiasis involves complex interactions of urinary promoters and inhibitors of crystallization. A variety of risk formulas have been established to approximate these interactions for clinical evaluation, and the aim of our study was to determine their usefulness as predictors of stone formation. The study cohort comprised 126 patients (63 boys and 63 girls) aged 6.7-18 years (mean age 14.1 +/- 2.9 years) with calcium urolithiasis (61 with chemically confirmed calcium oxalate stones and 65 children with a strong clinical suspicion of this type of urolithiasis). Of these, 36 children were classified as recurrent stone-formers, whereas the remaining 90 had experienced only one stone episode. The values obtained were compared to those of a control group of 60 age- and gender- matched healthy children. A number of crystallization risk indices were calculated from analytes obtained in 24-h urine: calcium/magnesium ratio (Ca/Mg), calcium/citrate ratio (Ca/Cit), (calcium x oxalate)/(magnesium x citrate) ratio (CaOx/MgCit), relative urinary CaOx supersaturation (RS(CaOx)), CaOx activity product index (AP(CaOx)), and standardized CaOx activity product index (AP(CaOx stand)). All indices, except for the AP(CaOx) index, were significantly higher in stone-formers than in the controls. The Ca/Mg, Ca/Cit, CaOx/MgCit, AP(CaOx), and AP(CaOx stand) indices were significantly higher in recurrent stone-formers than in first-episode ones. However, the determination of precise cutoffs between pathological and non-pathological values was problematic due to a considerable overlap of individual values. Based on our results, we conclude that calculation of the majority of risk indices may play a rather supplementary role in the evaluation of children with calcium urolithiasis.

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Metabolic Evaluation of Children with Urolithiasis: Are Adult References for Supersaturation Appropriate?

Cited by 9 publications

References 13 publications

Role of urinary supersaturation in the evaluation of children with urolithiasis

Role of urinary supersaturation in the evaluation of children with urolithiasis

Urolithiasis in infants

Assessment of crystallization risk formulas in pediatric calcium stone-formers

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