Pediatric Calculi: Cause, Prevention and Medical Management

Cesare M. Scoffone; Cecilia M. Cracco

Disclosures

Curr Opin Urol. 2018;28(5):428-432. 

In This Article

Metabolic Workup

Up to 90% of children with stone disease have an underlying metabolic disorder,[10,12] with a 50% risk of recurrent stones, compared with less than 10% in those without any identifiable risk factor; therefore, they should all undergo extensive metabolic evaluation, including serum studies and 24-h urine collection (spot urine samples can be collected in younger patients not yet toilet-trained).

Low urine volume, elevated supersaturation of calcium phosphate and calcium oxalate, hypercalciuria are the most commonly identified abnormalities on analysis of 24-h urine collections.[1,14,15] Hypercalciuria, hyperoxaluria and hypocitraturia are higher in children with new stone formation, hyperoxaluria and cystinuria significantly higher in stone persistence.[23]

Urinalysis should evaluate pH, glicosuria, proteinuria, hematuria, pyuria, urine culture.

Creatinine levels would be measured to asses overall renal function.[2] Electrolyte serum levels measurement should include calcium, magnesium, phosphorous, uric acid. Parathyroid hormone and vitamin D levels should be evaluated in case of hypercalciuria.

A 24-h urine excretion of calcium, oxalate, uric acid, citrate, magnesium, phosphorous, sodium, potassium, cystine (at least two or three collections in adults) is obtained to have an appropriate 'lithorisk' profile of the child with nephrolithiasis.

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