UrolithiasisThe Risk of Recurrent Urolithiasis in Children Is Dependent on Urinary Calcium and Citrate
Section snippets
Material and Methods
This study analyzes a dataset from a cohort that has been described in a previous publication.5 The data are from a retrospective cohort study that was performed of all children who presented with urolithiasis at a single pediatric institution between 1999 and 2006. Inclusion criteria included patients with a presumed calcium-based renal or ureteral stone based on stone analysis or radiographic imaging and who had at least one 24-hour urinary metabolic evaluation after diagnosis. Exclusion
Results
A total of 148 samples from 88 children with solitary stone formation and 84 samples from 51 children with recurrent stone formation were included in the analysis (Table 1). The mean age of the solitary group was 12.5 years, while that of the recurrent group was 13.1 years. The age range for both groups was 3-18 years. The 2 groups were similar in gender (49% of patients with solitary and 46% of those with recurrent stones were female). Mean follow-up after diagnosis was 3.7 years in the
Comment
The incidence of pediatric urolithiasis is increasing in many western countries including the United States.7, 8, 9 These children can present with severe abdominal and flank pain often leading to hospitalization and occasionally resulting in invasive surgical procedures. Families and patients are thus motivated after this experience to evaluate potential causes for the stone and address any metabolic factors that might predispose them to future episodes of renal colic. A previous family
Conclusions
After the first calcium stone episode, children found to have abnormal values for urinary calcium and citrate are at a significantly higher risk for recurrent nephrolithiasis. Clinicians may thus be able to identify patients for more extensive metabolic evaluation and/or pharmacologic therapy to help decrease recurrent stone formation. A clinical trial to investigate the effects of an intensive prophylactic regimen is needed to assess whether intervention decreases morbidity and improves
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Cited by (41)
Enteral nutrition and the risk of nephrolithiasis in complex pediatric patients
2022, Journal of Pediatric UrologyCitation Excerpt :Children tend to have a high recurrence rate when compared to adults [4]. We have previously shown high rates of urinary metabolic abnormalities in recurrent stone formers including hypercalciuria and hypocitraturia [5,6]. In our institution, a multi-disciplinary Pediatric Stone Center was created in 2014 due to the rising numbers of children being seen with kidney stones.
Analysis of urine composition from split 24-h samples: use of 12-h overnight samples to evaluate risk factors for calcium stones in healthy and stone-forming children
2020, Journal of Pediatric UrologyCitation Excerpt :We focused on the Ca/Cit ratio for evaluation of the risk of calcium stones because previous studies reported this ratio is more strongly related to stone formation than the absolute amount of each solute [8,29]. Thus, a Ca/Cit ratio higher than 0.33 in a 24-h urine sample reliably discriminated Ca stone formers from healthy children [30], and those with the highest ratios had more severe disease [31,32]. We found that the Ca/Cit ratio was significantly higher in the 12-h overnight samples of both groups.
Association Between Daily Water Intake and 24-hour Urine Volume Among Adolescents With Kidney Stones
2020, UrologyCitation Excerpt :The wide availability of smart water bottles such as those used in this study would allow patients to operationalize this FP by measuring this additional water volume during the course of their everyday lives. This study differs from previous studies of urine volume among patients with kidney stones, which have largely focused on the inability to maintain high water intake and associated low urine volume.15,18-22 Rather, we estimated the relationship between daily water intake and 24-hour urine volume in order to generate knowledge that helps patients achieve urine output goals to prevent stone recurrence.
24 Hour urine metabolic differences between solitary and multiple stone formers: Results of the Collaboration on Urolithiasis in Pediatrics (CUP) working group
2017, Journal of Pediatric UrologyCitation Excerpt :Interestingly, the mean urinary citrate level was higher in the multiple stone group; however, again, the values for both groups were within the accepted reference ranges. However, as mentioned in prior studies [6,7], interpretations of these results rely heavily on previously established reference ranges of pediatric urinary parameters. Previously published studies of our cohort and other studies support that many urinary parameters change significantly with age [14–16].
Calcium-to-Citrate Ratio Distinguishes Solitary and Recurrent Urinary Stone Forming Children
2017, Journal of Urology