Gouru Vijayabhaskar Reddy, Pogula Vedamurthy Reddy, Vaddi Surya Prakash, Manne Venu, Byram Ranadheer, Kadiyala Lalith Sagar
Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India.
Department of Urology and Renal Transplantation, Virinchi Hospitals, Hyderabad, Telangana, India.
Urol Ann. 2018 Jan-Mar;10(1):94-99. doi: 10.4103/UA.UA_98_17.
The aim of the study is to identify the prevalence of metabolic abnormalities in children with urolithiasis.
This is a prospective study; all children below 15 years who are found to have urolithiasis were prospectively evaluated with relevant history, clinical examination, and urine and serum testing. Metabolic workup includes complete urine examination, urine culture and sensitivity, and 24-h urinary analysis (lithorisk profile).
A total of 55 patients are included in the study. Forty-two are boys and 13 are girls aged between from 8 months to 15 years. Thirty-three patients underwent stone analysis, primary composition of calcium oxalate stones in 19 (58%), ammonium urate in 4, dahlite in 3 and uric acid in 3, silicon oxide in 2, and struvite in 2 cases. Lithorisk profile was performed in 40 cases (72.7%). The pH range is 5.6-6.2. We noted hypercalciuria in 20 patients (50%), hyperuricosuria in 23 (57.5%), hyperoxaluria in 20 (50%), hypernatriuria in 26 (65%), hypocitraturia in 9 (23%), and hypomagnesuria in 3 (7.5%). Urine calcium-to-creatinine ratio >0.2 was found in 22 (55%) patients. Statistically significant association between hyperoxaluria and hyperuricosuria ( < 0.04, = 0.32) and hypercalciuria and hyperuricosuria ( < 0.001, = 0.51) found in this study. Hyperuricosuria is seen in 75% and 73% of patients with hypercalciuria and hyperoxaluria, respectively. Twenty-five children have both lithorisk profile and stone analysis. Hypercalciuria and hyperoxaluria were noted in 60% of calcium oxalate stone formers each. Elevated urinary calcium/creatinine ratio (>0.2) was seen in 73% of calcium oxalate stone formers.
Because of high prevalence of metabolic risk factors and the significant risk of lifelong recurrence, all children with urolithiasis need complete evaluation with metabolic workup.
本研究旨在确定尿路结石患儿代谢异常的患病率。
这是一项前瞻性研究；对所有15岁以下被发现患有尿路结石的儿童进行前瞻性评估，包括相关病史、临床检查以及尿液和血清检测。代谢检查包括完整的尿液检查、尿培养及药敏试验以及24小时尿液分析（结石风险评估）。
本研究共纳入55例患者。其中42例为男孩，13例为女孩，年龄在8个月至15岁之间。33例患者进行了结石成分分析，草酸钙结石19例（58%）、尿酸铵结石4例、透辉石结石3例、尿酸结石3例、氧化硅结石2例、磷酸铵镁结石2例。40例（72.7%）患者进行了结石风险评估。pH值范围为5.6 - 6.2。我们发现20例患者（50%）有高钙尿症，23例（57.5%）有高尿酸尿症，20例（50%）有高草酸尿症，26例（65%）有高钠尿症，9例（23%）有低枸橼酸尿症，3例（7.5%）有低镁尿症。22例（55%）患者尿钙/肌酐比值>0.2。本研究发现高草酸尿症与高尿酸尿症之间存在统计学显著关联（<0.04，=0.32）以及高钙尿症与高尿酸尿症之间存在统计学显著关联（<0.001，=0.51）。高尿酸尿症在高钙尿症和高草酸尿症患者中分别占75%和73%。25名儿童同时进行了结石风险评估和结石成分分析。草酸钙结石形成者中60%有高钙尿症和高草酸尿症。草酸钙结石形成者中73%尿钙/肌酐比值升高（>0.2）。
由于代谢危险因素的高患病率以及终身复发的显著风险，所有尿路结石患儿都需要通过代谢检查进行全面评估。
