Risk factors for recurrence in pediatric urinary stone disease


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Demirtaş F., Çakar N., Özçakar Z. B., Akıncı A., Burgu B., Yalçınkaya F.

Pediatric Nephrology, vol.39, no.7, pp.2105-2113, 2024 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 39 Issue: 7
  • Publication Date: 2024
  • Doi Number: 10.1007/s00467-024-06300-0
  • Journal Name: Pediatric Nephrology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, CINAHL, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.2105-2113
  • Keywords: Children, Metabolic disorder, Outcome, Recurrence, Risk factors, Urolithiasis
  • Ankara University Affiliated: Yes

Abstract

Background: Children’s urinary system stones may develop from environmental, metabolic, anatomical, and other causes. Our objective is to determine the recurrence and prognosis, demographic, clinical, and etiological characteristics of children with urolithiasis. Methods: Medical records of patients were evaluated retrospectively. Patients’ demographic data and medical history, serum/urine biochemical and metabolic analysis, blood gas analysis, stone analysis, imaging findings, and medical/surgical treatments were recorded. Results: The study included 364 patients (male 187). Median age at diagnosis was 2.83 (IQR 0.83–8.08) years. The most common complaints were urinary tract infection (23%) and urine discoloration (12%). Sixty-two percent had a family history of stone disease. At least one metabolic disorder was found in 120 (88%) of 137 patients having all metabolic analyses: hypercalciuria was found in 45%, hypocitraturia in 39%, and hyperoxaluria in 37%. Anatomical abnormalities were detected in 18% of patients. Of 58 stones analyzed, 65.5% were calcium and 20.6% were cystine stones. Stone recurrence rate was 15% (55/364). Older age (> 5 years), family history of stone disease, stone size (≥ 5 mm), and urinary system anatomical abnormalities were significantly associated with stone recurrence (p = 0.027, p = 0.031, p < 0.001, and p < 0.001, respectively). In adjusted logistic regression analysis, stone size ≥ 5 mm (OR 4.85, 95% CI 2.53–9.3), presence of urinary system anatomical abnormalities (OR 2.89, 95% CI 1.44–5.78), and family history of stone disease (OR 2.41, 95% CI 1.19–4.86) had increased recurrence rate. Conclusions: All children with urolithiasis should be evaluated for factors affecting stone recurrence. Children at higher risk of recurrence need to be followed carefully. Graphical abstract: [Figure not available: see fulltext.].