SELÇUK YÜKSEL, Hazal Tancer ELÇİ, Ali KOÇYİĞİT, Melis DENİZ, Tülay BECERİR, Havva EVRENGÜL

Metabolic risk factors in children with urolithiasis: Single centre experience in southwest Turkey

Amaç: Ürolitiazisli çocukların demografik, klinik özelliklerini ve metabolik risk faktörlerini araştırmak.Gereç ve yöntem: Bu retrospektif çalışmada ultrasonografi ile tanı alan ürolitiazisli 98 hasta ( 48 erkek, 50 kız ) çalışmaya alındı. Başvuru yaş ortalaması 59.8 ay ve takip süresi ortalama 5,5 aydı.Klinik ve laboratuvar bulgular olarak cinsiyet, tanı anındaki yaş, ailede üriner taş hikayesi, izleme periyodu, başlangıç semptomları, idrar yolu enfeksiyon öyküsü, mikroskobik veya makroskobik hematüri varlığı, piyüri, üriner metabolik hastalık, kan tetkikleri, taş analizi, tedavi modalitesi ve prognoz belirlendi.Bulgular: En sık görülen belirti bebeklerde huzursuzluk ( < 1 yaş) ve daha büyük çocuklarda karın veya yan ağrısıydı. Mikrokalkul ( taş çapı < 3mm ) ve kalkül (taş çapı > 3mm ), hastaların sırasıyla % 29.6 ve % 70.4 'ünde saptandı. Hiperkalsiüri hastalarda en sık saptanan anormallik olurken, hipomagnezüri 2. sıklıkta onu takip etti. Hiperkalsiüri olgularının yaklaşık yarısı 1 yaş altındaydı. Tekrarlayan idrar yolu enfeksiyonu hastaların yarısında tespit edildi. Dört hastaya extrakorporal şok dalga litotripsi uygulandı, 4 hastaya açık ameliyat yapıldı ve diğer 90 hasta konservatif tedavi ile tedavi edildi. Spontan pasaj 17 hastada görüldü. Taş analizi ile 17 hastanın % 82.4 'ünde kalsiyum oksalat taşı olduğu saptandı. Son kontrolde, konservatif tedavi alan hastaların % 70'inde taşların kaybolduğu veya uygun tedavi ile küçüldüğü saptandı.Sonuç: Taşların kaybolması veya boyutunun küçülmesi açısından, 1 yaş altındaki çocuklar büyük çocuklara gore daha çok dezavantaja sahip gibi görünmektedir. Çalışmamızda bu vakaların 3/5'inde üriner metabolik anormallik saptanması nedeni ile çocuklarda mikrokalkülün metabolik açıdan değerlendirilmesi önemlidir

Ürolitiazisli çocuklarda metabolik risk faktörleri: Güneybatı Türkiye'den tek merkez deneyimi

Purpose:To investigate the demographic characteristics, clinical features, and metabolic risk factors of children with urolithiasis.Materials and methods:This retrospective study included 98 patients (48 boys, 50 girls) with urolithiasis diagnosed by ultrasonography. The mean age at presentation was 59.8 months, and the mean followup period was 5.5 months. Clinical and laboratory data including gender, age at diagnosis, presence of family history of renal stone, follow-up duration, presenting symptoms, the history of urinary tract infection (UTI), stone localization, presence of anatomical abnormalities of the urinary tract, presence of microscopic or macroscopic hematuria, pyuria, urinary metabolic examinations, blood tests, analysis of stone composition, treatment modality, and prognosis were assessed.Results: The most common symptom was restlessness in infants (<1year) and abdominal or flank pain in older children. Microcalculi (stone diameter <3mm) and calculi (>3mm) were found in 29.6% and in 70.4% of the patients, respectively. Hypercalciuria was the most common abnormality, followed by hypomagnesiuria. Nearly half of the hypercalciuria cases were <1 year old. Recurrent urinary tract infection was detected in half of the patients. Four patients underwent extracorporeal shock-wave lithotripsy, four underwent open surgery, and the other 90 were treated with conservative treatment. Spontaneous passage occurred in 17 patients. Stone analysis revealed calcium-oxalate in 82.4% of the 17patients. At the time of their last visit, 70% of the patients that were treated with conservative treatment, either had stones that disappeared or diminished in size with appropriate therapy.Conclusion: In terms of stones disappearance or decrease in the size of the stones, it seems that children younger than 1 year have more disadvantages than older children. Microcalculi in children should be taken into consideration because we found that 3/5 of these cases had urinary metabolic abnormalities

Kaynakça

Gillespie RS, Stapleton FB. Nephrolithiasis in children. Pediatr Rev 2004;25:131-139.

Ertan P, Tekin G, Oger N, Alkan S, Horasan GD. Metabolic and demographic characteristics of children with urolithiasis in western Turkey. Urol Res 2011;39:105-110.

López M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pediatr Nephrol 2010;25:49- 59.

Parvin M, Shakhssalim N, Basiri A et al. The most

important metabolic risk factors in recurrent urinary stone formers. Urol J 2011;8:99-106.

SirinA, Emre S, Alpay H, Nayir A, Bilge I, Tanman F.

Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 1995;9:549-552.

Turkey National Hemodialysis, Transplantation and

Nephrology Registry Report of Turkey 2009.Avaliable at: http://www.tsn.org.tr/folders/file/tsn_registry_2009. pdf.(Accessed April 2013).

Gürgöze MK, Sarı MY. Results of medical treatment and metabolic risk factors in children with urolithiasis. Pediatr Nephrol 2011;26:933-937.

Dursun I, Poyrazoglu HM, Dusunsel R et al. Pediatric urolithiasis: an 8-year experience of singlecentre. Int Urol Nephrol 2008;40:3-9.

Mortazavi F, Mahbub Al. Clinical features and

risk factors of pediatric urolithiasis. Iran J Pediatr 2007;17:129-133.

Erbagci A, Erbagci AB, Yilmaz M, et al. Pediatric

urolithiasis-evaluation of risk factors in 95 children. Scand J Urol Nephrol 2003;37:129-133.

Bak M, Ural R, Agin H, Serdaroglu E, Calkavur S. The

metabolic etiology of urolithiasis in Turkish children . Int Urol Nephrol 2009;41:453-460.

Edvardsson V, Elidottir H, Indridason OS, Palsson R.

High incidence of kidney stones in Icelandic children. Pediatr Nephrol 2005;20:940-944.

Acar B, InciArikan F, Emeksiz S, Dallar Y. Risk

factors for nephrolithiasis in children. World J Urol 2008;26:627-630.

Hoppe B, Leumann E, Milinler DS. Urolithiasis and

Nephrocalcinosis in Childhood. In: Geary DF, Schaefer F, editors. Comprehensive pediatric nephrology. Philadelphia: Mosby 2008;499-525.

Mathew JL. Antibiotic prophylaxis following urinary tract infection in children: a systematic review of randomized controlled trials. Indian Pediatr 2010;47:599-605.

Sas DJ. An update on the changing epidemiology and

metabolic risk factors in pediatric kidney stone disease. Clin J Am Soc Nephrol. 2011;6:2062-2068.

Fowler KA, Locken JA, Duchesne JH, Williamson

MR. US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology. 2002;222: 109-113. 27. Ulusan of for stone: comparison with CT. J Clin Ultrasound 2007;35: 256-261. Tokmak N.Accuracy detecting renal