Üriner Sistem Taş Hastalığı Olan Çocukların Metabolik Değerlendirmesi

Amaç: Üriner sistem taş hastalığı tanısal metodların yaygınlaşması, hareketsiz yaşam tarzının giderek artması ve beslenme alışkanlığındaki değişik-liklere bağlı olarak çocuklarda daha sık görülmeye başlanmıştır. Erişkinlere nazaran çocuklar metabolik risk faktörlerinin varlığı nedeni ile taşa bağlı morbiditeye maruz kalabilmektedirler. Bu çalışmada, ürolitiyazisli çocukların metabolik etiyolojilerinin ve medikal tedaviye cevaplarının değerlendi-rilmesi amaçlandı. Gereç ve Yöntem: Üriner sistem taş hastalığı nedeniyle tedavileri yapılan ve düzenli olarak iki ayda bir izlenen çocukların metabolik risk faktörleri ve tedaviye verdikleri yanıtlar değerlendirildi. Taş hastalığı ultrasonografi ve/veya tomografi ile tespit edildi. Tüm olgularda 24 saatlik idrarda kalsi-yum, ürik asit, oksalat, sitrat, sistin ve fosfat ölçümleri yapıldı. Bulgular: Çalışmaya alınan 196 olgunun tanı esnasındaki yaşları 3.9 yıl (3ay-16 yaş) ve takip süresi 4.2 yıl (3 ay-8 yıl) idi. En sık başvuru yakınmala-rının karın ve yan ağrısı (%30.6) olduğu görüldü. Hiperürikozüri (n:59, %23.8), hipositratüri (n:55, %22.2) ve hiperkalsiüri (n:51, %20.6) sık görülen metabolik anormallikler idi. Hastalar altta yatan metabolik bozukluğa göre tedavi edildiler. Son kontrollerinde 102 hastada (%52) taşın kaybolduğu, 28’inde (%14.3) küçüldüğü, 51’inde (%26) değişiklik olmadığı ve 15 hastada (%7.7) ise taş boyutunda artış olduğu belirlendi. Sonuç: Üriner sistem taşı olan çocuklarda belirlenen metabolik nedene uygun tedavi planlanması ile hem cerrahi yöntemlere ihtiyaç göstermeden medikal tedavi ile başarı sağlanabilmekte hem de yeni taş oluşumu önlenebilmektedir.

Metabolic Evaluation of Children with Urolithiasis

Objective: Urinary system stone disease has become more common in children due to the widespread use of diagnostic methods, an increase in sedentary lifestyles and changes in nutrition habits. Compared to adults, children are exposed to stone-related morbidity due to the presence of meta-bolic risk factors. In this study, it was aimed to evaluate the metabolic etiologies of children with urolithiasis and their medical care response. Material and Method: Metabolic risk factors and treatment responses were evaluated for children who were treated for urinary system stone disease and regularly monitored bimonthly. Stone disease was detected by ultrasonography and / or computed tomography. Calcium, uric acid, oxalate, cit-rate, cystine and phosphate measurements were performed in 24-hour urine in all cases. Results: The median age at diagnosis of urolithiasis in 196 children was 3.9 years (range: 3 months-16 years), and follow-up duration was 4.2 years (range: 3 months-8 years). The most common presenting symptoms were flank or abdominal pain (30.6%). Hyperuricosuria (n:59, %23.8), hypocitra-turia (n:55, %22.2) and hypercalciuria (n:51, %20.6) was the most common metabolic abnormality. The patients who had metabolic risk factors were treated according to underlying metabolic abnormalities. At the last control visit, while about half of the patients (%52) were stone free, the stones were diminished in size in 28 patients (%14.3); there was no change in the size of the stone in 51 patients (26%), whereas stone size increased in 15 patients (7.7%). Conclusion: By planning appropriate treatment for the metabolic abnormalities determined in children with urolithiasis, success can be achieved in many patients by medical treatments without the need of surgical methods.

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Fırat Tıp Dergisi-Cover
  • ISSN: 1300-9818
  • Başlangıç: 2015
  • Yayıncı: Fırat Üniversitesi Tıp Fakültesi