Nefrolitíase em pacientes pediátricos: investigação metabólica e anatômica

Abstract

Metabolic disorders are frequently observed in pediatric patients with renal lithiasis. Objectives: Study the metabolic and anatomical alterations and perform the chemical analysis of stones found in children with nephrolithiasis in our region. Methods: A retrospective study on 158 children with evidence of recent renal stone formation was performed. One hundred and nine children concluded the metabolic study. Laboratory investigation consisted in two samples of 24-hour urine for calcium, uric acid, citrate, oxalate, sodium and creatinine; qualitative cystinuria, urinary pH following 12-hour fasting and water restriction, urine culture and chemical analysis when the stones were available. Renal imaging techniques included, at least, renal ultrasound and excretory urogram. Results: A cause for nephrolithiasis was identified in 96.3% of children. The main metabolic alteration was hypercalciuria (73.4%). Chemical analysis of stones showed calcium oxalate in 90.9% of the cases. Anatomical alterations were found in 18.0% of the investigated cases and the most frequently found alteration was pyelo-ureteral duplication (28.6%). Conclusions: Hypercalciuria was the most frequently found disorder and pyelo-ureteral duplication was the most common anatomical alteration; moreover, calcium oxalate was the most frequent chemical constituent. The present study showed the characteristics of pediatric patients with nephrolithiasis in our region.

Oral Zinc Sulfate as Adjuvant Treatment in Children With Nephrolithiasis: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial

“…Also factors such as metabolic disorders like hypercalciuria, hypocitraturia etc. and genitourinary abnormalities can predispose nephrolithiasis in children ( 12 - 14 ). Previous studies have shown that citrate, magnesium, pyrophosphate, certain glycosaminoglycans, nephrocalcin and phytates have inhibitory role in the formation of the most common urinary stones, namely calcium oxalate and calcium phosphate ( 11 ).…”

Perfil epidemiológico da nefrolitíase na faixa etária pediátrica no Distrito Federal

“…Cabe destacar que a nefrolitíase em crianças pode ocorrer em qualquer idade, mas, geralmente, tem seu diagnóstico entre 7 e 10 anos de idade (1,7,10). Na primeira década de vida, a litíase renal costuma ser mais prevalente no sexo masculino, enquanto na segunda década de vida, o sexo feminino é o mais acometido (4,7,10).…”

“…Cabe destacar que a nefrolitíase em crianças pode ocorrer em qualquer idade, mas, geralmente, tem seu diagnóstico entre 7 e 10 anos de idade (1,7,10). Na primeira década de vida, a litíase renal costuma ser mais prevalente no sexo masculino, enquanto na segunda década de vida, o sexo feminino é o mais acometido (4,7,10). Esses dados, no entanto, podem ser variáveis, uma vez que o perfil epidemiológico não é tão bem definido como na faixa etária adulta, já que não existem muitos estudos sobre essa condição em crianças e adolescentes (4).…”

“…Já as desordens metabólicas se apresentam com um papel essencial na faixa etária pediátrica, uma vez que a maioria das crianças portadoras de litíase, até 96,3%, possui alguma dessas alterações (7,15). As condições mais prevalentes são: hipercalciúria idiopática, hipocitratúria, hiperuricosúria, hiperoxalúria, hipomagnesiúria e hiperfosfatúria (4,14).…”

What do we know about pediatric renal microlithiasis?

“…Metabolic abnormalities can be found in majority of pediatric patients with renal stone and RM ( 5 , 43 , 44 ). Due to the high risk of recurrences in childhood nephrolithiasis and RM, especially if associated with treatable conditions such as idiopathic hypercalciuria, hypocitraturia, renal tubular acidosis and cystinuria, a complete metabolic evaluation is indicated in all children with nephrolithiasis and RM ( 3 , 45 ).…”