Üriner Sistem Taş Hastalığı Olan Çocukların Retrospektif Analizi
Özet
Kavgacı, U, Retrospective Analysis of Children with Urinary Tract Stone Disease, Hacettepe University School of Medicine, Department of Pediatrics, Thesis of Pediatrics, Ankara, 2022. Urinary tract stone disease is an important health problem with an increasing incidence in children and negatively affecting kidney health and quality of life in the long term. In contrast to the adult patients, etiological factors that predispose to stone formation can often be detected in pediatric patients. Metabolic abnormalities (i.e. hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, cystinuria), structural urinary system anomalies and recurrent urinary tract infections take the most important place. In this study, demographic data, co-morbid conditions, presenting complaints, laboratory and imaging findings, treatments and outcomes of patients who were diagnosed within 0-18 years of age were retrospectively evaluated. 308 children (179 boys, 129 girls) were included in the study. The median age at diagnosis was 12.5 (0-214) months, and the median follow-up period was 34 (1-238) months. There was consanguineous marriage between parents in 31.2% of the patients, and individuals with a family history of stone disease in 59.9%. The most frequent presenting symptom was hematuria (48.7%), other frequent symptoms were abdominal pain (28.2%), dysuria (22.1%), and spontaneous stone passage (19.8%). There was at least one additional urinary tract disease in 35.7% of the patients. The most common urinary tract diseases were frequent UTI (18.5%). 34.7% of the patients had at least one accompanying systemic disease. Cystinuria was detected in 14 patients and primary hyperoxaluria was detected in 2 patients. At the first admission, 46.5% of the patients had hypocitraturia, 36% had hyperoxaluria and 11.3% had hypercalciuria. When all the test results obtained during the follow-up were analyzed, 70.3% of the patients had at least one hypocitraturia, 56.1% had hyperoxaluria and 40.7% had hyperuricosuria. Stone analysis was performed in 22.1% of all patients, and calcium oxalate was found in 61.7% and cystine stone in 19.1%. While 32.3% of the patients had only one stone, 46.3% had three or more stones. Stones were detected in the last ultrasound (US) in 36.8% of the patients. When the first and last imaging results were compared, there was a statistically significant decrease in stone detection rates (p<0.001). After the first evaluation, 69.2% of the patients were started on at least one medication. The most frequently initiated drugs were Shohl's solution (41.9%), potassium citrate (33.1%) and antibiotic prophylaxis (9.7%). According to the stone size in the first imaging, the group with the highest rate of patients followed without treatment was the group with stone size of <5 mm, and there was a statistically insignificant difference between this group and the group with stone size >10 mm in follow-up without treatment (p=0.078). 22.4% of the patients were hospitalized at least once due to stone, 21.8% underwent extracorporeal shock wave lithotripsy, 8.8% percutaneous nephrolithotomy, 12.3% ureterorenoscopy and 2.3% open stone surgery. In the subgroup analyzes for cystinuria patients, the number of stones in the first US was higher (p=0.022) and the stone were larger (p<0.001). The rates of hospitalization (p<0.001), percutaneous nephrolithotomy and ureterorenoscopy application (p<0.001), double J stent insertion (p=0.009) and open surgery (p=0.002) were higher in cystinuria patients. In conclusion, urinary tract stone disease in children is not rare and patients should be carefully investigated to identify risk factors. Although the prognosis is usually good, it is crucial to initiate appropriate preventive treatments and continue follow-ups to protect patients’ quality of life and kidney health, especially in children with an underlying risk factor.
