Prevalence and Pathophysiology of Pediatric Urolithiasis - A Review

Urolithiasis is a condition in which hard deposits made of salts and minerals are accumulated inside the kidneys. A lot of studies demonstrated adult urolithiasis but studies on pediatric urolithiasis is still scarce. Studies had shown that pediatric urolithiasis prevalence is progressively increasing worldwide. The main cause for this increase is not totally clear but has been associated to changes in climate, nutritional habits and other environmental factors. Pediatric urolithiasis is distinctive and different from adult urolithiasis concerning prevalence, etiology and clinical presentation. Over the time while the condition was evolving, the main cause has changed from predominantly infectious to metabolic in nature. Pediatric urolithiasis should not be underestimated as it is associated with morbidity mainly since it possesses a striking feature which is ability to recur. Metabolic risk factors are more communal in pediatric urolithiasis than in adults. The common type of calculi in children is comprised of either calcium oxalate or calcium phosphate mainly and is often associated with a metabolic abnormality. Informed as metabolic abnormalities, Idiopathic hypercalciuria and hypocitraturia are the most frequently reported. A good understanding of the causes and risk factors of pediatric urolithiasis will provide better strategies and techniques for calculi treatment and prevention in children.

Is There an Association between Childhood Obesity and Pediatric Kidney Stone Disease? A Literature Review

Objectives: To examine the most recent literature and published science in determining any and all possible associations between pediatric obesity and pediatric urolithiasis. Methods: Retrospective literature review of pediatric stone formers with diagnosed stone disease and all associated risk factors. Peer-reviewed, published manuscripts from the past several decades were analyzed for risk factors associated with pediatric obesity such as diet, hypertension, and renal diseases. Comparing the pediatric obesity literature with the pediatric stone forming literature, any associations and correlations were derived and analyzed. Results: Despite the existing evidence that obesity is linked to stones in adults, the evidence remains unclear whether obesity plays a role in children. Nutritional discrepancies, in the setting of the obesity epidemic, have been shown to alter the risk profile of pediatric patients. Consistent with the published literature, and lack of consistent correlation with obesity and stone disease, is the knowledge that age, gender, geography, and climate may all play a role in the onset of pediatric obesity and may also be on the causal pathway toward pediatric urolithiasis. Conclusion: The manuscript demonstrates that there are a number of risk factors, congenital or acquired, that are associated with pediatric obesity. The mechanisms responsible for these associations may be on the causal pathway toward childhood urolithiasis. These mechanisms that underlie these associations need to be further investigated.

Endourological management of pediatric urolithiasis in Northeast India

Background: Urolithiasis affects between 5-10% of the population during their lifetime, 2-3% of them are children. In the last decade, technological advancement and miniaturization of instruments has changed the management of pediatric urinary-stone disease. Extracorporeal shockwave lithotripsy (ESWL) has been preferred method of management of pediatric stone disease, whereas the endoscopic approach is limited to a few centers.Methods: This retrospective study was conducted among the pediatric patients (6-15 years) presenting with urolithiasis during 1st January 2017 to 31st December 2019 to the department of urology, Dispur hospital Pvt. Ltd., Assam. Only confirmed cases of pediatric urolithiasis were included in this study. Medical records were reviewed for clinical and laboratory data including gender, age at diagnosis, clinical presentation, presence of urinary tract anomalies, and urinary tract infections (UTI) in the form of urinalysis, urine culture and complete blood count. Metabolic evaluation was advised in all children. Finally, a total of 100 pediatric urolithiasis cases were included in this study.Results: ESWL was performed in 28 children. The stone-free rate was 85.7%. The total number of shocks per treatment ranged from 1000 to 2000. A total of 10 percutaneous nephrolithotomy (PCNLs) were done with complete stone clearance in 83.33%. In the URS group, urethroscopy was successful in 20 cases (75%). Cystolithotripsy was done in 08 cases with 100% clearance rate. 30 patients were managed conservatively.Conclusions: ESWL is highly effective in children for small stone burden. Early metabolic evaluation and treatment may prevent further renal damage and recurrence.