Department of Urology, Division of Pediatric Urology, Children's Wisconsin, Milwaukee, WI, USA.
Division of Pediatric Nephrology, Department of Pediatrics American Family Children's Hospital, Madison, WI, USA.
J Pediatr Urol. 2022 Feb;18(1):26.e1-26.e9. doi: 10.1016/j.jpurol.2021.11.012. Epub 2021 Nov 25.
Children with nephrolithiasis have a 50% risk of recurrence 3 years following an index urinary stone event. The American Urological Association guidelines for medical management of nephrolithiasis suggest metabolic evaluations be stratified according to risk of future stone events. However, no such risk stratification exists across the pediatric population with urinary stone disease. We aim to assess the risk factors among pediatric patients for a subsequent stone event (SSE).
A retrospective review for children <17 years of age with a diagnosis of nephrolithiasis and at least one completed follow-up at two tertiary-care children's hospitals within our state between 2012 and 2017 was performed. Children with known monogenic stone disease were excluded as well as those with follow-up less than 1 year. SSEs following initial diagnosis and treatment for nephrolithiasis were defined as follows: subsequent surgical intervention, new stone on imaging, reported stone passage, or ED evaluation for renal colic. Clinical and demographic factors were compared between patients with and without SSEs and analyzed using univariate and multivariate analyses via Cox proportional hazard models. Survival curves for significant associations for SSEs were generated and evaluated using Log-Rank and Wilcoxon comparisons.
A total of 200 patients with median clinical follow-up of 2.9 years were analyzed. Median age was 11.5 years (IQR: 6.0-15.5), with 109 (54.5%) males and 91 (45.5%) females, 94 (47%) of whom had a relevant comorbidity. An SSE occurred in 82 patients (41.0%). Age >12 (HR 2.21, 95%CI 1.42-3.45), reported stone event prior to enrollment encounter (i.e. personal history of nephrolithiasis) (HR 1.82, 95%CI 1.14-2.89), and family history of nephrolithiasis (HR 1.62, 95%CI 1.05-2.51) were associated with SSE on univariate analysis while age >12 (HR 2.09, 95%CI 1.33-3.27) and personal history of nephrolithiasis (HR 1.63, 1.02-2.6) retained significance on multivariable analysis. Survival analysis shows increased risk of recurrence with accumulation of risk factors (Summary Figure). Sensitivity analysis accounting for missing family history data retained significance for all three variables.
Adolescent age and a personal history of nephrolithiasis are independent risk factors for SSE in children. Understanding these risk factors and the nature of SSE among the pediatric population can potentially enhance counseling for further metabolic work-up and tailored clinical follow-up.
儿童肾结石患者在首次尿路结石事件后 3 年内有 50%的复发风险。美国泌尿科协会（AUA）肾结石医学管理指南建议根据未来结石事件的风险对代谢评估进行分层。然而，儿科尿路结石疾病患者并没有这样的风险分层。我们旨在评估儿科患者发生后续结石事件（SSE）的风险因素。
对 2012 年至 2017 年间在我们州的两家三级儿童医院接受肾结石诊断且至少完成一次随访的<17 岁儿童进行了回顾性研究。排除已知单基因结石病的儿童以及随访时间<1 年的儿童。将肾结石初始诊断和治疗后出现的 SSE 定义为：后续手术干预、影像学上出现新结石、报告结石排出或因肾绞痛到 ED 就诊。通过单变量和多变量分析 Cox 比例风险模型比较有和无 SSE 患者的临床和人口统计学因素。使用 Log-Rank 和 Wilcoxon 比较生成并评估 SSE 显著关联的生存曲线。
共分析了 200 名患者，中位临床随访时间为 2.9 年。中位年龄为 11.5 岁（IQR：6.0-15.5），其中 109 名（54.5%）为男性，91 名（45.5%）为女性，94 名（47%）有相关合并症。82 名（41.0%）患者发生了 SSE。年龄>12 岁（HR 2.21，95%CI 1.42-3.45）、就诊前有结石事件史（即肾结石个人史）（HR 1.82，95%CI 1.14-2.89）和肾结石家族史（HR 1.62，95%CI 1.05-2.51）在单变量分析中与 SSE 相关，而年龄>12 岁（HR 2.09，95%CI 1.33-3.27）和肾结石个人史（HR 1.63，1.02-2.6）在多变量分析中仍有意义。生存分析显示，随着危险因素的积累，复发风险增加（总结图）。考虑到缺失的家族史数据的敏感性分析保留了所有三个变量的意义。
青少年年龄和肾结石个人史是儿童 SSE 的独立危险因素。了解这些风险因素以及儿科人群中 SSE 的性质，有可能增强对进一步代谢评估和个性化临床随访的咨询。
