为什么儿童尿石症的发病率在增加？病因、诊断和治疗：单中心经验。
Why is childhood urolithiasis increasing? Etiology, diagnosis and management: a single-center experience.
机构信息
Pediatric Nephrology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey.
Radiology, Elazig Fethi Sekin City Hospital, Elazığ, Turkey.
出版信息
J Nephrol. 2023 Jul;36(6):1599-1604. doi: 10.1007/s40620-023-01638-4. Epub 2023 May 9.
BACKGROUND
Globally, urolithiasis is becoming more and more common among children. We aimed to determine the etiology, and the diagnostic and therapeutic approaches in patients with urolithiasis.
METHODS
This was a retrospective study which included all patients (aged 1 month-18 years) admitted to the pediatric nephrology clinic in Elazığ Fethi Sekin City Hospital with urolithiasis between November 2019 and 2021. Only patients whose diagnosis of urolithiasis was confirmed by urinary ultrasonography were included in the study, while patients with chronic diseases (neurological diseases such as epilepsy, cerebral palsy, chronic bowel diseases, etc.) predisposing to kidney stone formation were not. Demographic characteristics, serum and urine biochemical parameters, urine metabolic and kidney stone metabolic and chemical analyses, urinary tract ultrasonography findings and treatment modalities were collected.
RESULTS
One hundred ninety-seven patients (91 female and 106 male) were included in the study. Hypervitaminosis D was detected in 4 (2%) patients, suppressed parathyroid hormone in 12 (6%) and hypercalcemia in 27 (14%) patients. Metabolic screening showed hypercalciuria in 69 (35%) patients, hypocitraturia in 39 (20%), hyperoxaluria in 15 (8%) and cystinuria in 6 (3%) patients. Eighty three (42%) patients had a positive family history for kidney stones. One hundred eighteen (60%) patients received potassium citrate treatment, 71 (36%) were given hydration and diet recommendations without medical treatment, 6 (3%) received tiopronin treatment, and 2 (1%) patients were treated surgically.
CONCLUSIONS
Our study suggests that Vitamin D supplementation at doses higher than 400 IU/day may be a risk factor for kidney stones in children. We observed that mothers tend not to give water to infants who are breastfed or formula-fed in the first year of life. K-citrate treatment can be a good option for prevention and dissolution of stones by alkalinization.
背景
在全球范围内，儿童尿路结石的发病率越来越高。本研究旨在明确尿路结石患儿的病因、诊断和治疗方法。
方法
这是一项回顾性研究，纳入了 2019 年 11 月至 2021 年期间在埃尔祖鲁姆费特希·塞金市医院儿科肾病科就诊的所有尿路结石患儿（年龄 1 个月至 18 岁）。仅纳入经尿液超声检查确诊尿路结石的患者，不纳入有易形成肾结石的慢性疾病（如癫痫、脑瘫、慢性肠道疾病等）的患者。收集了患者的人口统计学特征、血清和尿液生化参数、尿液代谢、肾结石代谢和化学成分分析、尿路超声检查结果以及治疗方法。
结果
共纳入 197 例患者（女 91 例，男 106 例）。4 例（2%）患者存在维生素 D 过量，12 例（6%）患者甲状旁腺激素受抑制，27 例（14%）患者血钙升高。代谢筛查显示 69 例（35%）患者存在高钙尿症，39 例（20%）患者存在低枸橼酸尿症，15 例（8%）患者存在高草酸尿症，6 例（3%）患者存在胱氨酸尿症。83 例（42%）患者有肾结石家族史。118 例（60%）患者接受枸橼酸钾治疗，71 例（36%）患者接受水化和饮食建议治疗，6 例（3%）患者接受硫普罗宁治疗，2 例（1%）患者接受手术治疗。
结论
本研究表明，儿童每日摄入超过 400IU 的维生素 D 补充剂可能是肾结石的一个危险因素。我们观察到，母亲在婴儿出生后的头 1 年，给母乳喂养或配方奶喂养的婴儿喝水较少。枸橼酸钾治疗可通过碱化来预防和溶解结石。
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