Renal stone disease has been regarded as an uncommon problem in children compared to adults. However, increased awareness of this problem in children may lead to early intervention preventing long-term consequences on the kidney and the urinary tract. This article reviews the epidemiology, pathogenesis, and the most common etiologies of renal stones in children. The clinical features and diagnostic and therapeutic modalities for the specific etiologies are also outlined. Using these guidelines may be helpful not only in the treatment but also in the prevention of renal stones.
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References
1.
1. LemannJ Jr.Composition of the diet and calcium kidney stones. N EnglJ Med. 1993;328:880-881.
2.
2. Sierakowski R, Finlayson B, Landes RR, et al. The frequency of urolithiasis in hospital discharge diagnosis in the United States. Invest Urol. 1978;15:483-491.
3.
3. Noe HN, Stapleton FB, Jerkins GR, et al. Clinical experience with pediatric urolithiasis.J Urol. 1983;129:1166-1168.
11. Basaklar AC, Kale N. Experiences with childhood urolithiasis. BrJ Urol. 1991; 67:203-205.
12.
12. Androulakakis PA, Michael V, Polychronopuolou S, et al. Paediatric urolithiasis in Greece. BrJ Urol. 1991; 67:206-209.
13.
13. Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc. 1993;68:241-248.
14.
14. Nimmannit S, Malasit P, Susaengrat W, et al. Prevalence of endemic distal renal tubular acidosis and renal stones in the northeast of Thailand. Nephron. 1996;72:604-610.
15.
15. Hari P, Bagga A, Vasudev V, et al. Aetiology of nephrolithiasis in north Indian children. Pediatr Nephrol. 1995;9: 474-475.
16.
16. Polinsky MS, Kaiser BA, Baluarte HJ, et al. Renal stones and hypercalciuria. Adv Pediatr. 1993;40:353-384.
18. Stapleton FB. Nephrolithiasis in children. Pediatr Rev. 1989;11:21-30.
19.
19. Barratt TM. Urolithiasis and nephrocalcinosis. In: Holliday MA, Barratt TM, Avner ED, eds. Pediatric Nephrology, 3rd ed.Baltimore: Williams and Wilkins; 1994:1070-1080.
20.
20. Diamond DA, Rickwood AMK, Lee PH, et al. Infection stones in children: a twenty-seven-year review. Urology. 1994;43:52-52.
21.
21. Shepherd P, Thomas R, Harmon EP. Urolithiasis in children: innovations in management. J Urol. 1988; 140:790-792.
22.
22. Polinsky MS, Kaiser BA, Baluarte HJ. Urolithiasis in childhood. Pediatr Clin North Am. 1987;34:683-710.
23.
23. Fleisch H. Inhibitors and promoters of stone formation. Kidney Int. 1978; 13:361-371.
24.
24. Smith L. Solutions and solute. Endocrinol Metab Clin North Am. 1990;19: 767-772.
25.
25. Coe FL, Nakgawa Y, Asplin J, et al. Role of nephrocalcinin in inhibition of calcium oxalate crystallization and nephrolithiasis. MinerElectrolyte Metab. 1994;20:378-384.
26.
26. Thompson B, Harwood-Nuss AL. Urolithiasis in a child: an uncommon presentation of an uncommon disease. Ann Emerg Med. 1995;25:837-840.
27.
27. McSherry E. Renal tubular acidosis in childhood. Kidney Int. 1981;20:799-809.
28.
28. Goldfarb S. The role of diet in the pathogenesis and therapy of nephrolithiasis. Endocrinol Metab Clin North Am. 1990;19:805-820.
29.
29. Urivetsky M, Kessaur D, Smith AD. Ascorbic acid overdosing: a risk factor for calcium oxalate nephrolithiasis. J Urol. 1992;147:1215-1218.
30.
30. Herzberg GZ, Fivush BA, Kinsman SL, et al. Urolithiasis associated with ketogenic diet. JPediatr. 1990;117:743-745.
31.
31. Pahira Jr.Management of the patient with cystinuria. Urol Clin North Am. 1987;14:339-346.
32.
32. Diament MJ, Malekzadeh M. Ultrasound and the diagnosis of renal and ureteral calculi. J Pediatr. 1986; 109; 980-983.
33.
33. Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N EnglJ Med. 1992;327:1141-1152.
34.
34. Milliner DS. Cystinuria. Endocrinol Metab Clin North Am. 1990; 19:889-907.
35.
35. Byrd DJ, Lind M, Brodehl J. Diagnostic and genetic studies in 43 patients with classic cystinuria. Clin Chem. 1991;37:68-73.
36.
36. Wasserstein AG, Stolley PD, Soper KA, et al. Case-control study of risk factors for idiopathic calcium nephrolithiasis. Miner Electrolyte Metab. 1987;13:85-95.
37.
37. Kleeman CR, Bohannan J, Bernstein D, et al. Effect of variations in sodium intake on calcium excretion in normal humans. Proc Soc Exp Biol Med. 1964;115:29-32.
38.
38. Kok DJ, lestrajA, Doorenbos CJ. The effects of dietary excesses in animal protein and in sodium composition and the crystallization kinetics of calcium oxalate monohydrate in urine of healthy men. J Clin Endocrinol Metab. 1990;71: 861-867.
39.
39. LemannJrJ, Gray RW, Maierhofer j, Cheung HS. The importance of renal net acid excretion as a determinant of fasting urinary calcium excretion. Kidney Int. 1986;29:743-746.
40.
40. Brown WW, Wolfson M. Diet as culprit or therapy. Med Clin North Am. 1993; 77:783-794.
41.
41. Parivar F, Low RK, Stoller ML. The influence of diet on urinary stone disease.J Urol. 1996;155:432-440.
42.
42. Bataille P, Charransol G, Gregoire I, et al. Effect of calcium restriction in renal excretion of oxalate and the probability of stones in the various pathophysiological group with calcium stones.J Urol. 1983;130:218-218.
43.
43. Levy FL, Adams-Huet B, Pak CYC. Ambulatory evaluation of nephrolithiasis: an update of a 1980 protocol. Am J Med. 1995;98:50-59.
44.
44. Baran DT. Hypercalciuria. Am JDis Child. 1982;136:667-668.
45.
45. Goldfarb S. Diet and nephrolithiasis. Annu Rev Med. 1994;45:235-243.
46.
46. HughesJ, Norman RW. Diet and calcium stones. Can Med Assoc J. 1992; 146:137-143.
47.
47. Curhan GC, Curhan SG. Dietary factors and kidney stone formation. Compr Ther. 1994;20:485-489.
48.
48. Curhan GC, Willett WC, Rimm EB, et al. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. NEngl JMed. 1993;328:833-838.
49.
49. Lemann JJ, PleussJA, Gray RW, et al. Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults. Kidney Int. 1991;39:973-983.
50.
50. LemannJj, Gray RW, PleussJA. Potassium bicarbonate, but not sodium bicarbonate, reduces urinary calcium excretion and improves calcium balance in healthy men. Kidney Int. 1989; 35:688-695.
51.
51. Cirillo M, Laurenzi M, Panarelli W, et al. Urinary sodium to potassium ratio and urinary stone disease. Kidney Int. 1994;46:1133-1139.
52.
52. Osorio AV, Alon US. The relationship between urinary calcium, sodium and potassium excretion and the role of potassium in treating idiopathic hypercalciuria. Pediatrics. 1997;100:675-681.
53.
53. Segura JW. Current surgical approaches to urolithiasis. Endocrinol Metab Clin North Am. 1990; 19:919-935.
54.
54. Thomas R, OrtenbergJ, Lee BR, et al. Safety and efficacy of pediatric ureteroscopy for management of calculous disease.JUroL1993;149:1082-1084.
56. Nijman RJM, Ackaert K, Scholtoneijer RJ, et al. Long-term results of extracorporeal shock wave lithotripsy in children.J Urol. 1989;142:609-611.
57.
57. Longo JA, Netto NR Jr.Extracorporeal shock-wave lithotripsy in children. Urology. 1995;46:550-552.
58.
58. Bhatia V, Biyani CS. Extracorporeal shock wave lithotripsy in urolithiasis. Int Surg. 1994;79:80-83.
59.
59. Kramolowsky EV, Willoughby BL, Loening SA. Extracorporeal shock wave lithotripsy in children. J Urol. 1987;137:939-941.
60.
60. Vandeursen H, Devos P, Baert L. Electromagnetic extracorporeal shock wave lithotripsy in children. J Urol. 1991;145:1229-1231.
61.
61. Newman DM, Coury T, LingemanjE, et al. Extracorporeal shock wave lithotripsy experience in children. J Urol. 1986;136:238-240.
62.
62. Mininberg DT, Steckler R, Riehle RA Jr.Extracorporeal shock-wave lithotripsy for children. AmJDis Child. 1988;142:279-282.
63.
63. Harmon EP, Neal DE, Thomas R. Pediatric urolithiasis: a review of research and current management. PediatrNephrol. 1994;8:508-512.
64.
64. Krysiewicz S. Complications of renal extracorporeal shock wave lithotripsy reviewed. Urol Radiol. 1992; 13:139-145.
65.
65. Kroovand RL, Harrison LH, McCullough DL. Extracorporeal shock wave lithotripsy in childhood. J Urol. 1987; 138:1106-1108.
66.
66. Sigman M, Laudone VP, Jenkins AD, et al. Initial experience with extracorporeal shock wave lithotripsy in children.J Urol. 1987;138:839-841.
67.
67. FrickJ, Kohle R, Kunit G. Experience with extracorporeal shock wave lithotripsy in children. Eur Urol. 1988;14:181-183.
68.
68. Aladjem M, BarrJ, Lahat E, et al. Renal and absorptive hypercalciuria: a metabolic disturbance with varying interchanging modes of expression. Pediatrics. 1996;97:216-219.
69.
69. Stapleton FB, the Southwestern Pediatric Nephrology Study Group. Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children. Kidney Int. 1990;37:807-811.
70.
70. Stapleton FB, Noe HN, Roy S III, et al. Hypercalciuria in children with urolithiasis. AmJ Dis Child. 1982;136: 675-678.
71.
71. Harangi F, Mehen K. Family investigations in idiopathic hypercalciuria. Eur JPediatr. 1993;152:64-68.
72.
72. Coe FL, ParksJH, Moore ES. Familial idiopathic hypercalciuria. N Engl J Med. 1979;300:337-340.
73.
73. Stapleton FB. Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach. Pediatr NephroL1994;8:756-761.
74.
74. Kalia A, Travis LB, Brouhard B. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr. 1981;99: 716-719.
75.
75. Alon US, Warady BA, Hellerstein S. Hypercalciuria in the frequency-dysuria syndrome of childhood.JPediatr. 1990;116:103-105.
76.
76. Vachvanichsanong P, Malagon M, Moore E. Urinary incontinence due to idiopathic hypercalciuria in children.J Urol. 1994;152:1226-1228.
77.
77. Sutton RAL. Diuretics and calcium metabolism. AmJKidney Dis. 1985;5:4-9.
78.
78. Coe FL, ParksJH, Bushinsky DA, et al. Chlorthalidone promotes mineral retention in patients with idiopathic hypercalciuria. Kidney Int. 1988;33:1140-1146.
79.
79. Fuss M, Peppersack T, Bergman P, et al. Low calcium diet in idiopathic urolithiasis: a risk factor for osteopenia as great as in primary hyperparathyroidism. BrJ Urol. 1990;65: 560-563.
80.
80. Coe FL, Favus MJ, Crockett T, et al. Effects of a low calcium diet on urine calcium excretion, parathyroid function and serum 1,25 (OH)2 D3 levels in patients with idiopathic hypercalciuria and in normal subjects. AmJMed. 1982;72:25-32.
81.
81. Lawoyin S, Sismilich S, Brown R, Pak CYC. Bone mineral content in patients with calcium urolithiasis. Metabolism. 1979;28:1250-1254.
82.
82. Malluche HH, Tschoepe W, Ritz E, et al. Abnormal bone histology in idiopathic hypercalciuria. J Clin Endocrinol Metab. 1980;50:654-658.
83.
83. Barkin J, Wilson DR, Manuel MA, et al. Bone mineral content in idopathic calcium nephrolithiasis. Miner Electrolyte Metab. 1985;11:19-24.
84.
84. Galosy R, Clarke L, Ward DL, Pak CYC. Renal oxalate excretion in calcium urolithiasis. J Urol. 1980;123: 320-323.
85.
85. Reusz GS, Dobos M, Byrd D. Urinary calcium and oxalate excretion in children. PediatrNephrol. 1995;9:3944-3944.
86.
86. Karlowicz MG, Katz ME, Adelman RD, et al. Nephrocalcinosis in very low birth weight neonates: family history of kidney stones and ethnicity as independent risk factors. J Pediatr. 1993;122:635-638.
87.
87. Katz ME, Karlowicz MG, Adelman RD, et al. Nephrocalcinosis in very low birth weight neonates: sonographic patterns, histological characteristics, and clinical risk factors. J Ultrasound Med. 1994;13:777-782.
88.
88. Alon US, Scagliotti D, Garola R. Nephrocalcinosis and nephrolithiasis in infants with congestive heart failure treated with furosemide. J Pediatr. 1994;125:149-151.
89.
89. Thomas WCJr.Urinary calculi in hypercalcemic states. Endocrinol Metab Clin North Am. 1990;19:839-849.
92. Pak CYC. Citrate and renal calculi: an update. Miner Electrolyte Metab. 1994; 20:371-377.
93.
93. Parks JH, Coe FL. A urinary calciumcitrate index for the evaluation of nephrolithiasis. Kidney Int. 1986;30: 85-90.
94.
94. Ackay T, Konukkoglu D, Celik C. Hypocitraturia in patients with urolithiasis. Arch Dis Child. 1996;74: 350-351.
95.
95. Norman ME, Feldman NI, Cohn RM, et al. Urinary citrate excretion in the diagnosis of distal renal tubular acidosis. JPediatr. 1978;92:394-400.
96.
96. Pak CYC, Koenig K, Khan R, et al. Physicochemical action of potassium magnesium citrate in nephrolithiasis. JBoneMinerRes. 1992;7:283-287.
97.
97. Hibbard EW, Wendzilak TR. Oxalate synthesis, transport and the hyperoxaluric syndromes. J Urol. 1989;141: 742-747.
98.
98. Earnest DL, Johnson G, Williams HE, et al. Hyperoxaluria in patients with ileal resection: an abnormality in dietary oxalate absorption. Gastroenterol- ogy. 1974;66:1114-1114.
104. Cochat P, Deloraine A, Olive F, et al. Primary hyperoxaluria type I: the therapeutic dilemma. Adv Nephrol. 1995;24:227-242.
105.
105. Danpure CJ, Jennings PR, Watts RWE. Enzymological diagnosis of primary hyperoxaluria type I by measurement of hepatic alanine:glyoxylate aminotransferase activity. Lancet. 1987;1: 289-291.
106.
106. Morgan SH, Danpure CJ, Bending MR, Eisinger AJ. Exclusion of primary hyperoxaluria type I (PH I) in end stage renal failure by enzymatic analysis of a percutaneous hepatic biopsy. Nephron. 1990;55:336-337.
107.
107. Milliner DS, EickholtJT, Bergstrahl EJ. Results of long-term treatment with orthophosphate and pyridoxine in patients with primary hyperoxaluria. N EnglJMed. 1994;331:1553-1558.
108.
108. Yendt ER, Cohanim M. Response to a physiologic dose of pyridoxine in type I primary hyperoxaluria. NEngl JMed. 1985;312:953-957.
113. Daeschner CW, Singleton EB, Curtis JC. Urinary tract calculi and nephrocalcinosis in infants and children. J Pediatr. 1960;57:721-732.
114.
114. Sakhaee K, PoindexterJR, Pak CYC. The spectrum of metabolic abnormalities in patients with cystine nephrolithiasis. J Urol. 1989;141:819-821.
115.
115. Dahlberg PJ, Van Den Berg CJ, Kurtz SB, et al. Clinical features and management of cystinuria. Mayo Clin Proc. 1977;52:533-542.
116.
116. Sakhaee K. Cystinuria: pathogenesis and treatment. MinerElectrolyte Metab. 1994;20:414-423.
117.
117. Rodriguez LM, Santos F, Malaga S, Martinez V. Effect of a low sodium diet on urinary elimination of cystine in cystinuric children. Nephron. 1995; 71:416-418.
118.
118. Streem SB, Hall P. Effect of captopril on urinary cystine excretion in homozygous cystinuria. J Urol. 1989; 142: 1522-1524.
147. Wilson DM, Liedthe RR. Modified enzyme-based colorimetric assay of urinary and plasma oxalate with improved sensitivity and no ascorbate interference: reference values and sample handling procedures. Clin Chem. 1991;37:1229-1235.
148.
148. Pak CYC. Cystine lithiasis. In: Resnick MI, Pak CY, eds. Urolithiasis-A Medical and Surgical Reference. Philadelphia: WB Saunders; 1990:133-133.
149.
149. Morganstern BZ, Milliner DS, Murphy ME, et al. Urinary oxalate and glycolate excretion patterns in the first year of life: a longitudinal study. JPediatr. 1993;123:248-251.
150.
150. Barratt TM, Kasidas GP, Murdoch I, Rose GA. Urinary oxalate and glycolate excretion and plasma oxalate concentration. Arch Dis Child. 1991; 66:505-503.
