The metabolic etiology of urolithiasis in Turkish children

Abstract

Pediatric urolithiasis is an endemic disease, especially in certain developing regions of the world, such as the Far East, and to a certain extent the Middle East and Turkey. The aim of the study is to determine the metabolic etiology and the prevalence of formation of urinary calculi in Turkish pediatric patients with urolithiasis. Seventy-two pediatric patients diagnosed as having urolithiasis were studied from 1999-2005 in Dr. Behcet Uz Child Disease and Surgery Education and Research Hospital Nephrology Department, Izmir, according to their presenting signs and clinical and laboratory findings. The other necessary tests were also applied to detect the etiology of the calculi formation. Of the 72 patients, 50 (69.4%) were male and 22 (30.6%) were female, with ages ranging from 2 to 168 months (mean age 72 +/- 35.7 months), and the male-to-female ratio of patients was 2.3. Twenty-four (33%) of them were diagnosed as having metabolic urolithiasis, 21 (30%) anatomic, 19 (26%) infectious and 8 (11%) idiopathic. The age at which urolithiasis was first diagnosed was found to be low in the metabolic and anatomic etiology groups (P = 0.028). Thirteen patients (18%) with urolithiasis were known to have a family history of stone disease, and in all of them metabolic etiology was considered to be the reason (P < 0.001). In all of the groups, the localization of the stone was found to be the upper urinary system most of the time, and in 17 (24%) with bilateral multiple stones, the etiology was found to be metabolic (P < 0.001). All of the patients were followed up for 3-72 months (mean 29.2 +/- 13.7 months), and four of them (5.5%) had recurrences. In order to prevent renal damage and recurrences in pediatric patients with urolithiasis in Turkey in whom the etiology is mostly metabolic, the illnesses must be investigated very cautiously, and their early diagnosis and treatment modalities must be considered.

Classical xanthinuria: a rare cause of pediatric urolithiasis

“…Five cases have been reported from Turkey. [2][3][4][5] The reported incidence rates of xanthine stones were 0.1, and 12% in Armenia (Arikyants, and Sarkissian), and Kuwait, respectively. which reveals that in countries where consaguineous marriages are more frequently encountered together with ethnic, and geographic differences, prevalence of xanthine stones increases.…”

Etiologic Factors and Management in Children with Nephrolithiasis

“…7,12,16,17 Çalışmamızda da literatürle uyumlu olarak medyan tanı yaşı 13 ay olarak bulunmuştur. Ülkemizden yapılan birçok çalışmada hastalığın erkeklerde daha sık görüldüğü bulunmuşsa da, 7,17,18 tam tersi sonuçları olan çalış-malar da mevcuttur. 6 Çalışmamızda ise erkek ve kız oranı birbirine oldukça yakın bulunmuştur.…”

“…Bu yakınmalar farklı serilerde %19,8 ile %61,3 arasında bildirilmektedir. 5,8,12,[16][17][18][19] Bizim çalışmamızda ise karın ağrısı (%45,7) en sık başvuru yakınması olarak saptanmış-tır. Hematüri ise çocukluk çağı ÜSTH'sinde en sık rastlanan klinik bulgu olarak göze çarpmaktadır.…”

“…5,8 Ülkemizden yapılan çalışmaların çoğunda ikinci sık-lıkta görülen başvuru yakınması olup sıklığı %14 ile %23,8 arasında değişmektedir. [17][18][19] Bizim serimizde bu oran %12,3 olarak saptanmıştır. Bu düşük oranın nedeni, ultrasanografinin günlük pratiğimizde daha kolay ulaşılabilir ve uygulanabilir olması yanında olguların daha erken tanı almasına bağlanabilir.…”

“…5,8,12,[16][17][18][19][20] Ancak bu çalışmaların çoğunda hastaların ancak bir kısmına metabolik değerlendirme yapılmıştır. Bak ve ark.nın İzmir'de yaptıkları çalışmada, 72 hasta içeren serilerinde 24 (%33.3) olguda metabolik bozukluk saptandığı belirtilmiştir.…”