Ahmet Midhat ELMACI, MUHAMMET İRFAN DÖNMEZ

Konya bölgesi üriner sistem taş hastalığında klinik özellikler ve metabolik risk faktörleri

Amaç: Üriner sistem taş hastalığı hem çocuk hem de erişkin yaş grubunda dünya genelinde artan bir insidansa sahiptir ve Türkiye gibi endemik ülkelerde önemli bir morbidite sebebidir. Bu çalışmada üriner sistem taş hastalığı tanısı ile takip edilen çocukların klinik özellikleri ve metabolik risk faktörleri incelenmiştir. Gereç ve Yöntem: Üriner sistem taş hastalığı tanısı almış hasta dosyaları geriye dönük incelendi. Hasta bilgileri, görüntüleme yöntemleri ve laboratuar sonuçları eksiksiz olan hastalar çalışmaya dâhil edildi. Ultrasonografi (US) ve varsa kontrassız BT sonuçlarından taş lokalizasyonu ve boyutları kaydedildi. Metabolik değerlendirme tuvalet eğitimi olmayan çocuklarda spot idrarda, daha büyük çocuklarda ise 24 saatlik idrarda okzalat, sitrat, sistin, kalsiyum, ürik asit, kreatinin düzeyleri ölçülerek yapıldı. Bulgular: Çalışmaya 107’si erkek, 100’ü kız olmak üzere toplam 207 hasta dâhil edildi. Erkek/kız oranı 1,1:1 iken, ortanca yaş 1,6 yıl (2 ay16,1 yıl) olarak bulundu. En sık görülen başvuru şikâyeti İYE (%25,1) olurken bunu sırasıyla, karın/yan ağrısı (%18,4), huzursuzluk (%17,4) ile mikroskobik ve/veya makroskobik hematüri (%15,5) takip etti. Metabolik anormallik 150 hastada (%72,5) saptanırken, en sık görülen anormallikler hipositratüri (51 hasta, %24,6) ve hiperkalsiüri (40 hasta, %19,3) idi. Sonuç: Konya bölgesinde pediatrik üriner sistem taş hastalığı olgularında altta yatan en sık metabolik anormallik hipositratüridir. Metabolik anormallikleri tespit edebilmek için her hastada gerekli inceleme yapılmalı ve erken dönemde uygun tedavi ile renal hasar riski en aza indirilmelidir.

Objective: Urinary stone disease is a growing entity in both children and adults. It is an important cause of morbidity in endemic countries such as Turkey. The aim of this study was to identify clinical features and metabolic disturbance of pediatric urinary stone disease in Konya province. Material and Methods: Retrospective analysis of patients with diagnosis of urinary stone disease was conducted. Those with complete demographics, imaging and laboratory results were included. Ultrasonography and computed tomography without contrast was used to obtain stone location and size. Metabolic analysis were based on spot urinary excretions in children without potty training where 24-hour urine samples were used to identify urinary oxalate, citrate, cystine, calcium, uric acid and creatinine levels. Results: A total of 107 males and 100 females were included in the study. Male/female ratio was 1.1 whereas median age was 1.6 years (range 2 months - 16.1 years). Most common complaint of admission was urinary tract infection (25.1%) followed by abdominal/side pain (18.4%), discomfort (17.4%) and microscopic/macroscopic hematuria (15.5%). Metabolic disturbances were found in 150 patients. Most common metabolic abnormalities were hypocitraturia (51 patients, 24.6%) and hypercalciuria (40 patients, 19.3%), respectively. Conclusion: Results of our study indicate most common metabolic abnormality in children with urinary stone disease in Konya province is hypocitraturia. Necessary test in order to evaluate metabolic disturbance should be obtained in every pediatric urolithiasis patient, thus the risk of renal morbidity should be decreased.

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