Dalkılınç Ayhan, Demirkan Hasan, Özçelik Gül
Department of Urology, Health Sciences University, Şişli Etfal Health Application Research Center, İstanbul, Turkey.
Department of Pediatric Urology, Health Sciences University, Şişli Etfal Health Application Research Center, İstanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Mar 21;53(1):46-48. doi: 10.14744/SEMB.2019.32858. eCollection 2019.
Urinary tract stones are less common in children than in adults. Determining the etiology is the most important step to achieve successful treatment and prevent future recurrence. The aim of this study was to investigate the clinical characteristics and possible risk factors for urinary stone disease in pediatric patients.
The data of 126 patients with urinary stone disease who were treated in a pediatric nephrology clinic between 2000 and 2014 were analyzed retrospectively. A total 126 patients were enrolled in the study: 70 (55%) male and 56 (45%) female patients were included. The complaints, age of diagnosis, family histories, and stone location were examined. Direct urine microscopic examination, complete urinalysis, and urine culture were performed for all of the patients. Calcium, uric acid, oxalate, citrate, magnesium, and cystine levels were measured in urine collected in a 24-hour period. Serum electrolyte, blood urea nitrogen, creatinine, calcium, phosphorus, uric acid, and albumin levels were measured. Urinary ultrasound was performed. Stone analysis was conducted using the X-ray diffraction method. The mean age of the patients was 55 months (range: 1-162 months) at presentation.
In all, 34% of the patients had a family history of urinary stone disease. The rate of previous urinary tract infection was 26%. It was determined that 34% of the patients had been taking vitamin D and 5% had been taking a high dose. Metabolic risk factors determined were: hypercalciuria in 41%, hypocitraturia in 30%, hyperoxaluria in 14%, hyperuricosuria in 10%, and cystinuria in 5%. Among the group, 81% of the patients had kidney stones, 6.5% had ureter stones, and 2.5% had bladder stones. Furthermore, it was determined that 45% of the stones were composed of calcium oxalate, 35% had calcium phosphate stones, 14.2% had uric acid stones, and 13.3% had cystine stones. In 52% of the cases, extracorporeal shock wave lithotripsy was performed, and 71% underwent surgical treatment.
Metabolic evaluation and stone analysis should be performed to prevent future recurrences in children with urinary stone disease and lifelong follow-up should be emphasized.
儿童尿路结石比成人少见。确定病因是实现成功治疗和预防未来复发的最重要步骤。本研究的目的是调查儿科患者尿路结石病的临床特征和可能的危险因素。
回顾性分析2000年至2014年在儿科肾脏病门诊接受治疗的126例尿路结石病患者的数据。本研究共纳入126例患者，其中男性70例（55%），女性56例（45%）。检查患者的主诉、诊断年龄、家族史和结石部位。对所有患者进行直接尿液显微镜检查、尿常规检查和尿培养。测定24小时收集尿液中的钙、尿酸、草酸盐、柠檬酸盐、镁和胱氨酸水平。测定血清电解质、血尿素氮、肌酐、钙、磷、尿酸和白蛋白水平。进行泌尿系统超声检查。采用X射线衍射法进行结石分析。患者就诊时的平均年龄为55个月（范围：1 - 162个月）。
总体而言，34%的患者有尿路结石病家族史。既往尿路感染率为26%。确定34%的患者一直在服用维生素D，5%的患者服用高剂量维生素D。确定的代谢危险因素有：高钙尿症41%，低枸橼酸尿症30%，高草酸尿症14%，高尿酸尿症10%，胱氨酸尿症5%。该组中，81%的患者有肾结石，6.5%有输尿管结石，2.5%有膀胱结石。此外，确定45%的结石由草酸钙组成，35%有磷酸钙结石，14.2%有尿酸结石，13.3%有胱氨酸结石。52%的病例进行了体外冲击波碎石术，71%接受了手术治疗。
对于患有尿路结石病的儿童，应进行代谢评估和结石分析以预防未来复发，并应强调终身随访。
