Abstract
Amaç: Çocuklarda böbrek taşı sıklığı, son zamanlarda beslenme alışkanlıklarındaki değişikliklere ve sedanter yaşama bağlı olarak artış göstermiştir. Bu çalışmada, merkezimizde Çocuk Nefroloji ve Çocuk Üroloji Klinikleri’nde böbrek taşı/üreter taşı (BT/ÜT) tanılarıyla takip edilen hastaların etiyolojik faktörlerini ve altı aylık izlem sonuçlarını değerlendirmek amaçlandı.
Gereç ve Yöntem: Aralık 2018- Aralık 2020 arasında BT/ÜT tanılarıyla Çocuk Nefroloji ve Üroloji Klinikleri’nde takip edilen hastalar çalışmaya dahil edildi. Hastaların başvuru şikayetleri, anne-baba akrabalığı, BT/ÜT açısından metabolik risk faktörleri, aldıkları tedaviler, cerrahi operasyonlar ve taşların varlığının 6 aylık takip sonucunda devam edip etmediği bilgileri kayıtlardan elde edildi.
Bulgular: Toplam 93 hasta (46 erkek, 47 kız) çalışmaya dahil edildi. Anne-baba akrabalığı hastaların %46,2’sinde mevcut iken, ailede taş öyküsü hastaların %78,5’inde saptandı. İdrarda bakılan metabolik risk faktörlerinden hiperürikozüri 11/83 (%13,3) hastada, hiperkalsiüri 12/93 (%12,9) hastada, hiperokzalüri 6/51 (%11,8) hastada, sistinüri 7/90 (%7,8) ve hipositratüri 2/41 (%4,9) hastada saptandı. Sistinüri olmadan BT/ÜT saptanan 20 hasta (%29.9) potasyum sitrat tedavisi almaktaydı. Altı ay takip edilen hastalar (n=27) içinde potasyum sitrat tedavisi alan (n=11) veya cerrahi operasyon uygulanan hastaların (n=10) hiçbirinde taşın boyutunda artış saptanmadı.
Sonuç: Hastaların çoğunda ailede taş öyküsü saptandı. Hiperürikozüri, BT/ÜT için en sık görülen risk faktörüydü. Potasyum sitrat tedavisi BT/ÜT’li hastalarda taş progresyonunun önlenmesinde faydalı olabilir.
References
- Sas DJ. An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease. Clin J Am Soc Nephrol. 2011;6:2062–8.
- Yousefichaijan P, Azami M, Ranjbaran M, Azami S, Rahmati S. Clinical signs, causes, and risk factors of pediatric kidney stone disease: a hospital-based case-control study. Nephrourology. 2017;9:e41668.
- Önen A. Çocuklarda üriner sistem taş hastalığı. Çocuk Cerrahisi Dergisi. 2013;27:8-32.
- Bal A, Şahbudak Bal Z, Alparslan C, Yavaşcan Ö, Anıl M, Anıl AB. Çocukluk çağı üriner sistem taş hastalığında etiyolojik faktörler ve te¬davi. Turk J Med Sci. 2013;33:1127-32.
- Matlaga BR, Schaeffer AJ, Novak TE, Trock BJ. Epidemiologic insights into pediatric kidney stone disease. Urol Res. 2010;38:453-7.
- Ertan P, Tekin G, Oger N, Alkan S, Horasan GD. Metabolic and demographic characteristics of children with urolithiasis in Western Turkey. Urol Res. 2011;39:105-10.
- Spivacow FR, Del Valle EE, Boailchuk JA, Sandoval Díaz G, Rodríguez Ugarte V, Arreaga Álvarez Z. Metabolic risk factors in children with kidney stone disease: an update. Pediatr Nephrol. 2020;35:2107-12.
- Izol V, Aridogan IA, Karsli O, Deger M, Satar N. The effect of prophylactic treatment with Shohl's solution in children with cystinuria. J Pediatr Urol. 2013;9:1218-22.
- Baştuğ F, Düşünsel R. Pediatric urolithiasis: causative factors, diagnosis and medical management. Nat Rev Urol. 2012;9:138-46.
- Safaei Asl A, Maleknejad S. Pediatric urolithiasis: an experience of a single center. Iran J Kidney Dis. 2011;5:309-13.
- Santos FMD, Peres AK, Mandotti MR, Peres LAB. Metabolic investigation in patients with nephrolithiasis. Einstein (Sao Paulo). 2017;15:452-56.
- Pak CY. Citrate and renal calculi: an update. Miner Electrolyte Metab. 1994;20:371-7.
- Pak CY. Medical management of urinary stone disease. Nephron Clin Pract. 2004;98:49-53.
- Pak CY, Fuller C, Sakhaee K, Preminger GM, Britton F. Long-term treatment of calcium nephrolithiasis with potassium citrate. J Urol. 1985;134:11-9.
- Ziemba JB, Matlaga BR. Guideline of guidelines: kidney stones. BJU Int. 2015;116:184-9.
- Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR et al; American Urological Assocation. Medical management of kidney stones: AUA guideline. J Urol. 2014;192:316-24.
- Carvalho M, Erbano BO, Kuwaki EY, Pontes HP, Liu JWTW, Boros LH et al. Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis. Urolithiasis. 2017;45:449-55.
- Afshar K, McLorie G, Papanikolaou F, Malek R, Harvey E, Pippi-Salle JL et al. Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol. 2004;172:1600-3.
- Tiselius HG. New horizons in the management of patients with cystinuria. Curr Opin Urol. 2010;20:169-73.
- Zu'bi F, Sidler M, Harvey E, Lopes RI, Hojjat A, Naoum N et al. Stone growth patterns and risk for surgery among children presenting with hypercalciuria, hypocitraturia and cystinuria as underlying metabolic causes of urolithiasis. J Pediatr Urol. 2017;13:357.e1-357.e7.
Abstract
Purpose: The incidence of pediatric nephrolithiasis/urolithiasis (NL/UL) has increased in the last few decades due to dietary habits and a sedentary lifestyle. This study aimed to determine the etiological factors and six months of follow-up results of patients with NL/UL in pediatric nephrology and urology clinics in our center.
Materials and Methods: Children with NL/UL between December 2018 and December 2020 were enrolled in this study. The medical records were reviewed to collect data about admission complaints, consanguinity, metabolic risk factors for NL/UL, medical treatments, surgical interventions, and presence of stones after 6 months of follow-up.
Results: A total of 93 patients (46 male and 47 female) were included in the study. Consanguinity and a positive family history for stones was present in 46.2% and 78.5% of patients, respectively. The urinary metabolic risk factors were hyperuricosuria (11/83, 13.3%), hypercalciuria (12/93, 12.9%), hyperoxaluria (6/51, 11.8%), cystinuria (7/90, 7.8%), and hypocitraturia (2/41, 4.9%). Twenty patients (29.9%) with NL/UL and without cystinuria received potassium citrate therapy. After 6 months of follow-up (n = 27) of these patients, stone progression was not observed in any of the patients who received potassium citrate treatment (n=11) or underwent surgical intervention (n=10).
Conclusions: Most patients had a family history of stones. Hyperuricosuria was the most common urinary risk factor for NL/UL. Potassium citrate therapy might be useful to prevent stone progression in patients with NL/UL.
References
- Sas DJ. An update on the changing epidemiology and metabolic risk factors in pediatric kidney stone disease. Clin J Am Soc Nephrol. 2011;6:2062–8.
- Yousefichaijan P, Azami M, Ranjbaran M, Azami S, Rahmati S. Clinical signs, causes, and risk factors of pediatric kidney stone disease: a hospital-based case-control study. Nephrourology. 2017;9:e41668.
- Önen A. Çocuklarda üriner sistem taş hastalığı. Çocuk Cerrahisi Dergisi. 2013;27:8-32.
- Bal A, Şahbudak Bal Z, Alparslan C, Yavaşcan Ö, Anıl M, Anıl AB. Çocukluk çağı üriner sistem taş hastalığında etiyolojik faktörler ve te¬davi. Turk J Med Sci. 2013;33:1127-32.
- Matlaga BR, Schaeffer AJ, Novak TE, Trock BJ. Epidemiologic insights into pediatric kidney stone disease. Urol Res. 2010;38:453-7.
- Ertan P, Tekin G, Oger N, Alkan S, Horasan GD. Metabolic and demographic characteristics of children with urolithiasis in Western Turkey. Urol Res. 2011;39:105-10.
- Spivacow FR, Del Valle EE, Boailchuk JA, Sandoval Díaz G, Rodríguez Ugarte V, Arreaga Álvarez Z. Metabolic risk factors in children with kidney stone disease: an update. Pediatr Nephrol. 2020;35:2107-12.
- Izol V, Aridogan IA, Karsli O, Deger M, Satar N. The effect of prophylactic treatment with Shohl's solution in children with cystinuria. J Pediatr Urol. 2013;9:1218-22.
- Baştuğ F, Düşünsel R. Pediatric urolithiasis: causative factors, diagnosis and medical management. Nat Rev Urol. 2012;9:138-46.
- Safaei Asl A, Maleknejad S. Pediatric urolithiasis: an experience of a single center. Iran J Kidney Dis. 2011;5:309-13.
- Santos FMD, Peres AK, Mandotti MR, Peres LAB. Metabolic investigation in patients with nephrolithiasis. Einstein (Sao Paulo). 2017;15:452-56.
- Pak CY. Citrate and renal calculi: an update. Miner Electrolyte Metab. 1994;20:371-7.
- Pak CY. Medical management of urinary stone disease. Nephron Clin Pract. 2004;98:49-53.
- Pak CY, Fuller C, Sakhaee K, Preminger GM, Britton F. Long-term treatment of calcium nephrolithiasis with potassium citrate. J Urol. 1985;134:11-9.
- Ziemba JB, Matlaga BR. Guideline of guidelines: kidney stones. BJU Int. 2015;116:184-9.
- Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR et al; American Urological Assocation. Medical management of kidney stones: AUA guideline. J Urol. 2014;192:316-24.
- Carvalho M, Erbano BO, Kuwaki EY, Pontes HP, Liu JWTW, Boros LH et al. Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis. Urolithiasis. 2017;45:449-55.
- Afshar K, McLorie G, Papanikolaou F, Malek R, Harvey E, Pippi-Salle JL et al. Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol. 2004;172:1600-3.
- Tiselius HG. New horizons in the management of patients with cystinuria. Curr Opin Urol. 2010;20:169-73.
- Zu'bi F, Sidler M, Harvey E, Lopes RI, Hojjat A, Naoum N et al. Stone growth patterns and risk for surgery among children presenting with hypercalciuria, hypocitraturia and cystinuria as underlying metabolic causes of urolithiasis. J Pediatr Urol. 2017;13:357.e1-357.e7.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Publication Date | March 31, 2022 |
| Acceptance Date | November 14, 2021 |
| Published in Issue | Year 2022 Volume: 47 Issue: 1 |
