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Fang AM, Gibson E, Oster RA, Dangle PP. Effect of age, BMI, and gender on urinary risk factors in pediatric idiopathic stone formers. J Pediatr Urol 2021; 17:477.e1-477.e9. [PMID: 34217589 PMCID: PMC8812992 DOI: 10.1016/j.jpurol.2021.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The incidence of pediatric urolithiasis has been increasing over the years; however, the etiology of this increase is not well understood. Age, body mass index, and gender have been examined as possible risk factors for stone disease, but with inconsistent and variable associations. OBJECTIVE We aim to investigate the urine chemistry factors, as assessed by 24-h urinary parameters, in pediatric stone formers at a large volume tertiary referral center in the highest areas in the United States, the Southeast, based on age, body mass index, and gender. STUDY DESIGN We retrospectively reviewed all pediatric stone formers who completed a 24-h study between 2005 and 2016. Patients were stratified by age (3-10 versus 11-18 years of age), overweight status (above versus below the 85th percentile for body mass index), and gender (male versus female) (Summary Figure). Statistical analysis included analysis of variance and logistic regression. RESULTS 243 patients were included in our analysis. Patients in the first decade of life were found to have greater numbers of urinary risk factors than those in the second decade. Non-overweight patients were more likely to have hyperoxaluria and hyperuricosuria, while overweight patients were more likely to have hypocitraturia. Female patients were more likely to have higher hyperoxaluria, while male patients were more likely to have hypercalciuria. DISCUSSION In contrast to prior publications, obesity is not linked to increased risk of urolithiasis with non-overweight individuals having a greater number of risk factors than the overweight cohort. Despite stone disease being more prevalent in adolescents, the greatest number of risk factors were present in the first decade of life. Lastly, female children had more urinary risk factors than males. Further understanding of the underlying causes of stone disease in various pediatric populations is warranted. CONCLUSION While more urinary risk factors were identified in younger, non-overweight, and female patients, there remains no consensus on the urinary risk factors for pediatric urolithiasis. Further study is needed to elucidate the risk factors and pathophysiology of pediatric stone disease.
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Affiliation(s)
| | - Elena Gibson
- University of Alabama at Birmingham, AL, USA; University of Utah, UT, USA
| | | | - Pankaj P Dangle
- University of Alabama at Birmingham, AL, USA; Children's of Alabama, Birmingham, AL, USA.
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Abstract
PURPOSE OF REVIEW The incidence of urolithiasis has shown a prominent increase in the last two to three decades and evidence-based data have clearly indicated the certain role of obesity and overweight in both children and adults. As a certain component of metabolic syndrome, 'obesity' has been found to have a significant impact on the urinary metabolic risk factors which may be important in stone formation. In this present review article, we aimed to evaluate the possible association between obesity and urolithiasis and related risk factors. The epidemiology, pathophysiology, and management of stone disease in obese cases will be discussed in detail. RECENT FINDINGS The possible influence of overweight/obesity on the metabolic stone-forming risk factors has been subjected to several studies which in turn well demonstrated the increased risk of stone formation in this population. Although the exact underlying mechanisms are still to be outlined, some certain pathogenetic factors, namely, changes in urinary pH and increased excretion of some urinary stone components have been well demonstrated. Given this increased risk status, these cases require a more comprehensive workup for urolithiasis. Appropriate metabolic evaluation-based medical therapy alongside dietary recommendations will be effective in preventing stone formation. SUMMARY Patients suffering from obesity problem have particular risk factors for urolithiasis when compared with their normal-weight counterparts. All efforts should be taken to increase the awareness of this problem and necessary precautions with well-planned treatment plan are the main tasks for urologists.
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Barata CB, Valete COS. CLINICAL-EPIDEMIOLOGICAL PROFILE OF 106 PEDIATRIC PACIENTS WITH UROLITHIASIS IN RIO DE JANEIRO, BRAZIL. REVISTA PAULISTA DE PEDIATRIA 2018; 36:261-267. [PMID: 30365808 PMCID: PMC6202900 DOI: 10.1590/1984-0462/;2018;36;3;00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/23/2017] [Indexed: 01/20/2023]
Abstract
Objective: To describe the frequency, clinical profile and treatment of patients with
urolithiasis in the Pediatric Nephrology Department of a public state
hospital in Rio de Janeiro, Brazil. Methods: Retrospective study. Data from pediatric patients (age: 1 month - 18 years)
with urolithiasis admitted between January/2012 and December/2014 were
reviewed from hospital charts. The studied variables were: demographic and
anthropometric data, clinical status, family history of urolithiasis,
urinary tract infection and use of lithogenic drugs, diagnostic procedures,
associated abnormalities, metabolic disorders, treatment and recurrence. Results: The frequency of urolithiasis was 13.6%. Main characteristics of the
patients: male gender, white race, eutrophy, aged between 5 and 10 years,
family history of urolithiasis, previous urinary infection and spontaneous
stone passage. Abdominal and flank pain and macroscopic hematuria were the
most common complaints. The most frequent metabolic disorders were
hypercalciuria, hyperuricosuria and hypocitraturia. Hypocitraturia was
associated with previous urinary infection (p=0.004). Abdomen/urinary tract
ultrasonography was the most commonly used diagnostic test. Hydronephrosis
occurred in 54.4% of the cases, 81.1% of the stones were in the kidneys, and
bilateral stones were associated to a family history of urolithiasis
(p=0.030). Recurrence rate was 29.3% (most patients had a metabolic
disorder). In 12.3%, the patients underwent lithotripsy, 24.5% were
surgically treated (mainly pyelolithotomy), and only 7.6% had their stones
analyzed (calcium oxalate was the main finding in the examined stones). Conclusions: The frequency of urolithiasis in these pediatric patients was similar to
that reported by the literature. A metabolic evaluation is required and the
composition of stones should be better evaluated.
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Chan KH, Moser EA, Whittam BM, Misseri R, Cain MP, Krambeck A. The ability of a limited metabolic assessment to identify pediatric stone formers with metabolic abnormalities. J Pediatr Urol 2018; 14:331.e1-331.e6. [PMID: 30177386 DOI: 10.1016/j.jpurol.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION American Urological Association guidelines recommend a urinary metabolic evaluation after the first stone event in all pediatric stone patients. Prior studies identified hypercalciuria and urine hypovolemia as the most common abnormalities in children with urolithiasis. Recent data suggest that hypocitraturia is most prevalent. It was hypothesized that a limited evaluation would detect the majority of clinically significant metabolic abnormalities in pediatric stone formers. MATERIAL AND METHODS A retrospective analysis of all children (<18 years of age) with renal/ureteral calculi evaluated at the study institution from 2005 to 2015 was performed. Children with ≥ one 24-h urinary metabolic profile after a clinical visit for renal/ureteral calculi were included. Those with bladder stones and those with undercollection or overcollection or missing urinary creatinine were excluded. Demographics and data from the first urinary metabolic profile and stone analyses were collected. The sensitivity, specificity, and positive and negative predictive value (NPV) of a limited urinary metabolic evaluation consisting of four parameters (24-h calcium, citrate, and oxalate and low urinary volume) were compared to a complete urinary metabolic profile. The number and type of metabolic abnormalities that would have been missed with this limited evaluation weredetermined. RESULTS Of 410 patients, 21 were excluded for age ≥18 years, 13 for bladder stones, 248 for overcollections, 38 for undercollections, and 10 for missing creatinine. This left 80 patients for inclusion: median age 11.4 years, 60% female, and 96.3% white. Of the entire cohort, 69.6% had hypocitraturia, 52.5% had low urine volume, and 22.5% had hypercalciuria. Sensitivity was 87.5%. Specificity could not be calculated because no patients had a normal complete metabolic evaluation. The NPV was zero, and the positive predictive value was 100%, but these are artifacts resulting from the absence of patients with a normal complete metabolic evaluation. Of the 80 patients, 10 had at least one abnormality missed by a limited metabolic evaluation (Table 1). The missed abnormalities were high pH (n = 6), abnormal 24-h phosphorus (low in 1 patient and high in 1 patient), low 24-h magnesium (n = 3), low 24-h potassium (n = 3), and high 24-h sodium (n = 4). DISCUSSION A limited urinary metabolic evaluation would have detected the vast majority of clinically significant metabolic abnormalities in the study sample. Approximately two-thirds of the study patients submitted inadequate 24-h urine specimens. CONCLUSIONS A simplified approach to metabolic evaluation in first-time stone formers with a stone analysis available was proposed. This streamlined approach could simplify the metabolic evaluation and reduce health care costs.
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Affiliation(s)
- K H Chan
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA; Center for Pediatric and Adolescent Comparative Effectiveness Research and Department of Biostatistics, 410 W. 10th St. Suite 2000, Indianapolis, IN 46202, USA.
| | - E A Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - B M Whittam
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - R Misseri
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - M P Cain
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
| | - A Krambeck
- Department of Urology, 535 Barnhill Dr. Indianapolis, IN, 46202, USA
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Murphy MO, Erpelding SG, Chishti AS, Dugan A, Ziada A, Kiessling SG. Influence of BMI in nephrolithiasis in an Appalachian pediatric population: A single-center experience. J Pediatr Urol 2018; 14:330.e1-330.e8. [PMID: 29887297 DOI: 10.1016/j.jpurol.2018.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/19/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The prevalence of pediatric nephrolithiasis has increased significantly in the past 20 years. Metabolic abnormalities predisposing adults to nephrolithiasis in obese patients include increased urinary sodium and uric acid excretion as well as low urine pH; however, limited data are available in the pediatric population. OBJECTIVE The aim was to investigate whether obese pediatric patients presenting with nephrolithiasis have a unique metabolic profile similar to reported findings in obese adults with nephrolithiasis. STUDY DESIGN A retrospective chart review was performed in children aged 1-18 years seen at Kentucky Children's Hospital between 2010 and 2016. Inclusion criteria included all patients with documented stones confirmed by ultrasonography or computed tomography. RESULTS A total of 111 patient charts were reviewed in the study with a mean age of 11.8 ± 4.2 years. Seventy patients (63%) had a normal BMI and 41 patients (37%) were considered overweight/obese. There was no statistically significant relationship between BMI and stone recurrence. Obese patients had significantly decreased levels of urinary citrate, oxalate, magnesium, and potassium with significant elevations of urinary urea nitrogen, ammonia, and low urine pH compared with normal weight patients (Summary Figure). DISCUSSION Several groups have reported on metabolic findings within obese and non-obese pediatric patients. A Turkish study reported increased oxalate excretion and hypocitraturia in obese patients while a Korean study also reported increased rates of hypocitraturia in recurrent stone formers. Similar to these studies, we did find significant differences in citrate within our study population; however, we found significantly lower levels of urinary oxalate in obese patients. The majority of these studies do not report an association with BMI and urine pH although this has been reported in the adult population and our findings support an inverse relationship between body mass index (BMI) and pH. Our group found a higher level of calcium phosphate stones, supporting of Eisner's findings that high BMI is associated with increased supersaturation of calcium phosphate. Limitations of our study include being a single center and retrospective in nature. CONCLUSION Our study demonstrates differences in types of stones and urinary metabolites in an obese pediatric population suggestive of different metabolic profiles contributing to stone disease. We report similar association between BMI and urine pH, urinary potassium, and citrate. This study confirmed our primary hypothesis that obese pediatric patients would have a different urinary mineral profile as evidenced by lower levels of citrate and potassium and low urine pH; however, obese patients did not exhibit significantly elevated urinary sodium and uric acid when normalized to weight, as described in the adult population. Our study did not confirm our secondary hypothesis that stone composition would be associated with BMI status or stone recurrence.
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Affiliation(s)
- Margaret O Murphy
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | | | - Aftab S Chishti
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Adam Dugan
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Ali Ziada
- Division of Urology, University of Kentucky, Lexington, KY, USA
| | - Stefan G Kiessling
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
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Abstract
PURPOSE OF REVIEW In this article, we aim to review the data regarding associations between obesity and nephrolithiasis to assist with workup and treatment of these intersecting disorders. As obesity has a multifactorial influence on the risk for urinary stone disease, the complicated mechanisms will be discussed to improve diagnosis and management. RECENT FINDINGS Obesity and metabolic syndrome interact with nephrolithiasis risk factors to produce a myriad of bodily responses that induce stone formation. For this reason, many societies recommend prompt metabolic workup to evaluate the precise causes of stone formation. Data have shown that dietary and directed medical therapies can produce an excellent therapeutic response in this patient population, although the response may be blunted compared with nonobese patients. SUMMARY Given the increasing number of obese and overweight patients, the urologist should be familiar with the pathophysiology, workup, and treatment of metabolic stone disease in this population, which are outlined here.
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Saitz TR, Mongoue-Tchokote S, Sharadin C, Giel DW, Corbett S, Kovacevic L, Bayne AP. 24 Hour urine metabolic differences between solitary and multiple stone formers: Results of the Collaboration on Urolithiasis in Pediatrics (CUP) working group. J Pediatr Urol 2017; 13:506.e1-506.e5. [PMID: 28526618 DOI: 10.1016/j.jpurol.2017.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Specific factors associated with the risk of developing pediatric urinary stone disease remain unclear, especially those that may be associated with recurrent stone disease. OBJECTIVE We compared the results of 24-h urine collections in children with a solitary stone episode to those with multiple stone episodes to determine if there is a difference that may be associated with multiple stone formation in children. STUDY DESIGN A multi-institutional retrospective analysis was completed to assess 24-h urinary metabolic profiles in children with urolithiasis aged 2-18 years old. Differences in mean urine collections between the two groups were assessed using chi-square tests to test the associations among gender, stone type, and multiple stone status, as well as multivariate analyses using general linear models. RESULTS We analyzed 142 solitary stone patients and 136 multiple stone patients from four centers were included. Multiple stone patients were older than solitary stone patients (mean 13.4 ± 3.6 years vs. 12 ± 3.9 years, p = 0.002). Females were more likely to have multiple stones (58% vs. 39%, p = 0.002). BMI was not associated with multiple stones (p = 0.8467). Multiple stone formers had lower urine volumes, although this did not reach statistical significance when compared with solitary stone formation (20.4 mL/kg/day ± 11.5 vs. 22.9 ± 13.0, p = 0.0880). Higher values for super-saturation of calcium oxalate were associated with multiple stone disease in univariate (p = 0.0485) and multivariate analysis (p = 0.0469) (Figure). Centers located in the Southeast of the United States saw a higher proportion of children with multiple stones (Tennessee 62.7%, Virginia 44.4%, Oregon 31.6%, Michigan 27.3%, p < 0.0001). DISCUSSION In a large multi-institutional retrospective analysis we found that multiple stone disease was associated with higher super-saturations of calcium oxalate. Many urinary parameters changed with patient age, highlighting that the values should be interpreted with respect to patient age. The inability to comment on follow-up because of the nature of our dataset is a limitation of this study. CONCLUSION Multiple stone disease in children is associated with higher super-saturation calcium oxalate, while lower urinary volume may also be associated with multiple stones; however, further study is required. Early metabolic evaluation may help risk stratify children likely to form multiple stones.
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Affiliation(s)
- Theodore R Saitz
- Oregon Health and Science University, Department of Urology, Portland, OR, USA
| | - Solange Mongoue-Tchokote
- Oregon Health and Science University, Biostatistics Shared Resource, Knight Cancer Institute, Portland, OR, USA
| | - Cynthia Sharadin
- University of Tennessee, Department of Urology, Memphis, TN, USA
| | - Dana W Giel
- University of Tennessee, Department of Urology, Memphis, TN, USA
| | - Sean Corbett
- University of Virginia, Department of Urology, Charlottesville, VA, USA
| | | | - Aaron P Bayne
- Oregon Health and Science University, Department of Urology, Portland, OR, USA.
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Mahakkanukrauh P, Sinthubua A, Das S. Re: Cambareri et al.: Do Overweight and Obese Pediatric Stone Formers Have Differences in Metabolic Abnormalities Compared With Normal-weight Stone Formers? (Urology 2017;101:26-30). Urology 2017; 105:210. [PMID: 28412330 DOI: 10.1016/j.urology.2017.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Excellence Center in Osteology Research and Training Center (ORTC) & Forensic Osteology Research Centre, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Sinthubua
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Cain MP. This Month in Pediatric Urology. J Urol 2016. [DOI: 10.1016/j.juro.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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