Pediatric Nephrolithiasis

Abstract

The prevalence of pediatric nephrolithiasis has increased dramatically in the past two decades for reasons that have yet to be fully elucidated. Workup of pediatric kidney stones should include metabolic assessment to identify and address any risk factors predisposing patients to recurrent stone formation, and treatment should aim to facilitate stone clearance while minimizing complications, radiation and anesthetic exposure, and other risks. Treatment methods include observation and supportive therapy, medical expulsive therapy, and surgical intervention, with choice of treatment method determined by clinicians’ assessments of stone size, location, anatomic factors, comorbidities, other risk factors, and preferences and goals of patients and their families. Much of the current research into nephrolithiasis is restricted to adult populations, and more data are needed to better understand many aspects of the epidemiology and treatment of pediatric kidney stones.

The Efficacy of Preoperative Tamsulosin on Ureteroscopy Access in Pediatrics: A Systematic Review and Meta-Analysis

“…Acute management of the condition comprises monitoring with supportive care, medical expulsive therapy (MET), and surgical intervention. 9 In the past, treatment for urinary tract stone diseases was performed by open surgeries, but recently there has been a significant drive toward minimally invasive surgery (MIS), such as extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), retrograde intrarenal surgery (RIRS), The use of ureteroscopy for stone management in children can be a good option. Straub, et al mentioned that the URS procedure is the most ideal procedure for stones in the mid and distal ureters.…”

“…Straub, et al mentioned that the URS procedure is the most ideal procedure for stones in the mid and distal ureters. 9 In a study conducted by Whatley A, et al, with an average age of 8.5 years showed that the use of ureteroscopy in the treatment of urolithiasis resulted in an 87% stone-free rate with an average operating time of 62 minutes. 11 Another research according to Nerli, et al found that the use of ureteroscopy as therapy in children under 60 months of age proved effective and safe in ureteral and renal pelvic stones.…”

Increased risk of nephrolithiasis: an emerging issue in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

“…Genetic and metabolic disorders leading to increased urinary excretion of calcium, oxalates and phosphates, decreased urine volume, urinary supersaturation, insufficient concentrations of crystallization inhibitors, such as citrate and magnesium, represent the most common causes of nephrolithiasis in children [ 14 , 15 ]. Recently, an increased risk of hypercalcemia, hypercalciuria and nephrocalcinosis has been reported in children with CAH, although the underlying pathogenetic mechanisms are unknown [ 16 , 17 ].…”

Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis

“…Serum levels of calcium, phosphorus, bicarbonate, magnesium, and uric acid should be determined as well. The most common metabolic anomalies are hypercalciuria, hyperoxaluria, hypocitraturia, cystinuria, and hyperuricosuria [8]. Hypercalciuria rates were 33.8-42% amongst pediatric patients, with idiopathic hypercalciuria (normocalcemia with hypercalciuria) being the leading form [9].…”