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Paper Information

Journal:   IRANIAN JOURNAL OF KIDNEY DISEASES (IJKD)   DECEMBER 2009 , Volume 3 , Number SUPPLEMENT 1 (12TH INTERNATIONAL CONGRESS OF NEPHROLOGY, DIALYSIS, AND TRANSPLANTATION); Page(s) 28 To 28.
 
Paper: 

URINARY STONES IN CHILDREN; METABOLIC FACTORS (POSTER PRESENTATIONS: P149)

 
 
Author(s):  NASERI M., VARASTEH A., ALAMDARAN S.A.
 
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Abstract: 

Introduction. Although pediatric urolithiasis is rare in Western countries, it remains a common health problem in some parts of the world. Some epidemiological studies have shown that annual incidence of urolithiasis in asymptomatic primary school children is 1%. Although metabolic defects, urinary stasis, and infection seem to be the major causes of stone disease in many Western countries, in countries where pediatric stone disease is considered to be endemic, the etiology remains idiopathic in the majority of the cases. Metabolic and genitourinary anomalies which predispose to urolithiasis often coexist in pediatric patients. Metabolic abnormalities have been reported in 30% to 86% of the children with urolithiasis depending on the location of the studies. Various anatomical abnormalities such as ureteropelvic junction obstruction, ureterocele, VUR, hydronephrotic renal pelvic or calices, calyceal diverticulums, horseshoe kidney, ureteral stricture, and tubular ectasia (medullary spongy kidney) promote urine stasis and increase the risk of stone formation. Natural inhibitors and promoters of crystal and stone formation exist in the urine. Natural inhibitors consist of magnesium, citrate, and glycoproteins. Glycoproteins (nephrocalcin and Tamm-Horsfall proteins) are probably extremely important inhibitors. This study was conducted to determine the association of metabolic risk factors in pediatric patients with nephrolithiasis.
Methods. Metabolic evaluation was done in 142 pediatric stone formers. Evaluation included serum biochemistry,
measurement of daily excretion of urinary calcium (Ca), uric Acid (UA), oxalate, citrate, Mg (in older children), and measurement of Ca, UA, Cr and oxalate in random urine samples (in non-toilet-trained patients) as well as urinary tests for cystinuria.
Results. A total of 61 patients (42.7%) had metabolic abnormalities. Anatomical abnormalities were found in 12 (8.4%) patients. Urinary analysis revealed hypercalciuria in 25 (17.6%), hyperuricosuria in 23 (16.1%), hyperoxaluria in 17 (11.9%), cystinuria in 9 (6.3%), hypocitraturia in 3(2.1%), and low urinary Mg level in 1 (0.7%) patients. Sixteen patients (11.2%) had mixed metabolic abnormalities.
Conclusion. Metabolic abnormalities are common in pediatric patients with urolithiasis. In our study, calcium and uric-acid abnormalities were the most common and VUR seemed to be the most common urological abnormality which leaded to urinary stasis and stone formation.

 
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