Publication:

Pediatric urolithiasis: What role does metabolic evaluation has to play?

Background Pediatric urolithiasis is a perplexing problem faced by pediatricians as well as urologists across the globe. By early diagnosis and treatment of these risk factors, future stone formation may be prevented.

Aim To evaluate the clinical, biochemical and metabolic characteristics of the patients and the interventions required to prevent recurrence.

Methods In this retrospective study, cohort of pediatric patients presenting with urolithiasis at Kasturba Medical College, Manipal formed the study population. Patient’s records served as study tools. Medical records department was approached and data was collected. Metabolic evaluation was done in all children. Urine tests included urinalysis, urine culture, 24 hours urinary pH, volume, calcium, oxalate, citrate, uric acid, and creatinine. Finally a total of 58 pediatric urolithiasis cases were included in this study.

Results Mean age of study subjects was 6.85±1.27 years. Top three presentations of pediatric urolithiasis were symptoms of Urinary tract infection (UTI), abdominal pain and flank pain in 29.3%, 24.1% and 17.2% children respectively. Gross hematuria was observed in 15.5% of cases. 82.6% of stones were renal stones. Calcium oxalate stone was most common (50%) variety found. Hyperoxaluria was the most common (79.3%) metabolic abnormality detected. 31% had stone recurrence during follow up and 8 of these had >1 metabolic abnormality. Only 6/28 (21.4%) patients managed conservatively had stone recurrence whereas 12/30 (40%) managed with a procedure had stone recurrence.

Conclusions Metabolic evaluation for urolithiasis helps us to identify children those at increased risk for recurrent stone disease. Thus metabolic evaluation is a must in all pediatric patients as it helps in segregating patients needing medical therapy.