Patient Characteristics Associated With Completion of 24-hour Urine Analyses Among Children and Adolescents With Nephrolithiasis

Lee, Albert S.; McGarry, Laura; Bowen, Diana K.; Tasian, Gregory E.

doi:10.1016/j.urology.2019.02.008

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Additionally, our institutions are tertiary care centers with a large referral population that may represent children more likely to have a 24-h urine evaluation recommended in their workup. Prior studies have also identified specific barriers to 24-h urine study completion, such as socioeconomic status and insurance status (12,13). However, our study was unable to evaluate those children for whom a 24-h urine study was recommended but not completed.…”

Section: Discussionmentioning

confidence: 94%

“…Stone-promoting medications: zonisamide, topiramate, furosemide, and prednisone. (12,13). The tension between the potential benefit of these evaluations weighed against the burden of 24-h urine collections emphasizes the importance to risk-stratify children who may benefit from this testing.…”

Section: Discussionmentioning

confidence: 99%

“…Children performing a 24-h urine analysis have been shown to have a 60% lower risk of stone recurrence, although the driving factors behind this association are unclear (2). While this evaluation can be beneficial in terms of highlighting underlying metabolic factors and guiding or reinforcing dietary strategies, they are expensive and logistically tasking on patients and their families (12,13). Consequently, those who are economically disadvantaged are at risk of not completing the evaluation (12).…”

Section: Introductionmentioning

confidence: 99%

“…While this evaluation can be beneficial in terms of highlighting underlying metabolic factors and guiding or reinforcing dietary strategies, they are expensive and logistically tasking on patients and their families (12,13). Consequently, those who are economically disadvantaged are at risk of not completing the evaluation (12). The combination of these barriers has led to low completion rates and inadequate collections of 24-h urine in pediatric patients (12).…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, those who are economically disadvantaged are at risk of not completing the evaluation (12). The combination of these barriers has led to low completion rates and inadequate collections of 24-h urine in pediatric patients (12). Furthermore, even when a sample is adequate, a normal collection may not lead to a change in management (2,13).…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With Abnormal Initial 24-Hour Urine Studies in Pediatric Nephrolithiasis: Can We Better Select Patients for Evaluation?

Moyer¹,

Ellison²,

Medairos³

et al. 2022

Front. Urol.

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BackgroundChildren, especially adolescents, constitute the most rapid growing demographic of nephrolithiasis. Due to the risks of recurrent stone disease, a 24-h urine analysis is recommended for the evaluation of children at risk of recurrent nephrolithiasis or those who are otherwise interested in further evaluation. However, data regarding patients most likely to have abnormal urine studies are sparse. We aim to identify predictors of abnormal 24-h urine studies in children presenting for evaluation of nephrolithiasis.MethodsA retrospective review of children ≤17 years of age with a diagnosis of nephrolithiasis at both primary children’s hospitals within our state from 2012 to 2017 was performed. Children with an adequate initial 24-h urine study (creatinine ≥9 mg/kg/24 h) not on a thiazide or potassium citrate during the study were included. Factors associated with any abnormality [calcium ≥4 mg/kg; oxalate ≥45 mg/1.73 m2; citrate ≤310 mg/1.73 m2 (girls) or ≤365 mg/1.73 m2 (boys)] were evaluated as well as magnesium, uric acid, volume, sodium, and phosphorus.ResultsA total of 111 children were included, 69 of whom (62%) had at least one abnormal result. Of factors hypothesized to be associated with an abnormal 24-h urine study, only sex was significant (p = 0.001). Boys had a greater proportion of hypercalciuria (55%) and hypocitraturia (73%) and a slightly lower proportion of hyperoxaluria (48%) than those in girls.ConclusionMale sex was the only factor associated with an abnormal 24-h urine study, largely driven by increased rates of hypercalciuria and hypocitraturia in boys.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%