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

The Changing Cause and Composition of Pediatric Nephrolithiasis

The cause of stone formation has shifted over time, with a transition in developed countries from infectious causes (up to 60% in some records[13]) to metabolic causes (up to 50%[16,17]). Early diagnosis and surgical treatment of urinary tract malformations promoting urine stasis and/or increasing the risk of infection,[17] and a better control of infections in developed countries are involved in this transformation.

Children or less 10 years of age are more likely to have a metabolic disorder including elevations in calcium, oxalate and supersaturation of calcium phosphate, whereas children more than 10 years of age are more likely to have a low urinary volume.[18]

Stone composition in children has been reported to be similar to those formed in adulthood according to some authors (75–80% predominantly calcium oxalate, 5–10% calcium phosphate, 10–20% struvite, 5% pure uric acid[1,15]), different than in adults by others (45% calcium oxalate, 25% calcium phosphate 25%, mixed with small amounts of uric acid[4,12]), whereas all authors are unanimous about the 17–22% rate of infective stones.[13,15] In any case, most kidney stones in children are calcium based.[2,12] The analysis of stones retrieved after spontaneous passage or after any kind of stone surgery should always be carried out.

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