Prevention and treatment of nephrolithiasis inchildhood – practical guidelines

Abstract

Pediatric nephrolithiasis is a chronic and recurrent condition characterized by the formation of calculi within the urinary system as a result of an imbalance between promoters and inhibitors of crystallization. Over recent decades, a persistent increase in its incidence has been observed in the pediatric population, attributed to changes in lifestyle, dietary patterns, reduced physical activity, and climatic influences. Elevated rates of metabolic abnormalities, family predisposition, insufficient fluid intake, excessive consumption of salt and animal protein, urinary tract infections, and certain congenital anomalies of the urinary tract are among the leading factors contributing to stone formation. Metabolic disturbances such as hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia are identified in more than two-thirds of affected children and play a critical role in recurrence. In childhood, the condition often presents with nonspecific symptoms, which may delay diagnosis and increase the risk of developing chronic kidney damage. The diagnostic process includes clinical evaluation, laboratory testing, and imaging studies, while treatment must be tailored to the underlying cause and to the type and composition of the calculi.

Prevention remains the most effective strategy and includes adequate hydration, a balanced diet with restricted salt and protein intake, weight control, treatment of infections, and regular follow-up. Early diagnosis and individualized therapy are essential for preventing recurrences and preserving renal function in children with nephrolithiasis.

Key words: nephrolithiasis, children, prevention, metabolic disorders, renal function

Bibliography

1. Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr. 2010;157(1):132–7. doi:10.1016/j.jpeds.2010.02.004.

2. Dwyer ME, Krambeck AE, Bergstralh EJ, Milliner DS, Lieske JC, Rule AD. Temporal trends in incidence of kidney stones among children: a 25-year population-based study. J Urol. 2012;188(1):247–52. doi:10.1016/j.juro.2012.03.021.

3. Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc. 1993;68(3):241–8. doi:10.1016/S0025-6196(12)60043-3.

4. Kalorin CM, Zabinski A, Okpareke I, White M, Kogan BA. Pediatric urinary stone disease—does age matter? J Urol. 2009;181(5):2267–71. doi:10.1016/j.juro.2009.01.050.

5. Rauturier C, Machon C, Demède D, Dubourg L, Bacchetta J, Bertholet-Thomas A. Composition of urinary stones in children: clinical and metabolic determinants in a French tertiary care center. Eur J Pediatr. 2021;180(12):3555–63. doi:10.1007/s00431-021-04151-7.

6. Cao B, Daniel R, McGregor R, Tasian GE. Pediatric nephrolithiasis. Healthcare (Basel). 2023;11(4):405. doi:10.3390/healthcare11040552.

7.  Cameron MA, Sakhaee K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol. 2005;20(11):1587–92. doi:10.1007/s00467-005-1883-z.

8.  Guidelines for management of a child with renal stone or nephrocalcinosis. 2009.

9.  Fallahzadeh MA, Hassanzadeh J, Fallahzadeh MH. What do we know about pediatric renal microlithiasis? J Renal Inj Prev. 2017;6(2):70–5. doi:10.15171/jrip.2017.13.

10. Shavit L, Jaeger P, Unwin RJ. What is nephrocalcinosis? Kidney Int. 2015;88(1):35–43. doi:10.1038/ki.2015.76.

11.  Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13 Suppl 3:S45–50.

12.  Alexander RT, et al. Kidney stones and kidney function loss: a cohort study. BMJ. 2012;345:e5287. doi:10.1136/bmj.e5287.

13. Coe FL, Evan AP, Worcester EM, Lingeman JE. Three pathways for human kidney stone formation. Urol Res. 2010;38(3):147–60. doi:10.1007/s00240-010-0271-8.

14. Moe OW. Kidney stones: pathophysiology and medical management. Lancet. 2006;367(9507):333–44. doi:10.1016/S0140-6736(06)68071-9.

15. Coward RJM, et al. Epidemiology of paediatric renal stone disease in the UK. Arch 16. Srivastava T, Alon US. Pathophysiology of hypercalciuria in children. Pediatr Nephrol. 2007;22(10):1659–73. doi:10.1007/s00467-007-0482-6.

17. Spivacow FR, Negri AL, del Valle EE, Calviño I, Fradinger E, Zanchetta JR. Metabolic risk factors in children with kidney stone disease. Pediatr Nephrol. 2008;23(7):1129–33. doi:10.1007/s00467-008-0769-2.

18. Edvardsson V, Elidottir H, Indridason OS, Palsson R. High incidence of kidney stones in Icelandic children. Pediatr Nephrol. 2005;20(7):940–4. doi:10.1007/s00467-005-1861-5.

19. Zuckerman JM, Assimos DG. Hypocitraturia: pathophysiology and medical management. Rev Urol. 2009;11(3):134–44.

20. Rellum DM, Feitz WF, Van Herwaarden AE, Schreuder MF. Pediatric urolithiasis in a non-endemic country: a single-center experience from the Netherlands. J Pediatr Urol. 2014;10(1):155–61. doi:10.1016/j.jpurol.2013.07.019.

21. Maalouf NM, Cameron MA, Moe OW, Sakhaee K. Novel insights into the pathogenesis of uric acid nephrolithiasis. Curr Opin Nephrol Hypertens. 2004;13(2):181–9. doi:10.1097/00041552-200403000-00006.

22. Cochat P, et al. Nephrolithiasis related to inborn metabolic diseases. Pediatr Nephrol. 2010;25(3):415–24. doi:10.1007/s00467-008-1085-6.

23. Reusz GS, Hosszu A, Kis E. Evaluation of a child with suspected nephrolithiasis. Curr Opin Pediatr. 2020;32(2):265–72. doi:10.1097/MOP.0000000000000880.

24. Kokorowski PJ, Hubert K, Nelson CP. Evaluation of pediatric nephrolithiasis. Indian J Urol. 2010;26(4):531–5. doi:10.4103/0970-1591.74453.

25. Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol. 2010;25(3):403–13. doi:10.1007/s00467-008-1073-x.

26. Gillespie RS, Stapleton FB. Nephrolithiasis in children. Pediatr Rev. 2004;25(4):131–9. doi:10.1542/pir.25-4-131.

27. Tasian GE, Copelovitch L. Evaluation and medical management of kidney stones in children. J Urol. 2014;192(5):1329–36. doi:10.1016/j.juro.2014.04.108.

28. Injeyan M, Bidault V, Bacchetta J, Bertholet-Thomas A. Hydration and nephrolithiasis in pediatric populations: specificities and current recommendations. Nutrients. 2023;15(3):728. doi:10.3390/nu15030728.

29. Gambaro G, et al. The risk of chronic kidney disease associated with urolithiasis and its urological treatments: a review. J Urol. 2017;198(2):268–73. doi:10.1016/j.juro.2016.12.135.

30. Велчовска Б, Жекова-Мараджиева Ж, Узунов А, Иванова Е, Петрова Д, Вълчев Г. Бъбречно-каменна болест (нефролитиаза) – патогенеза, видове и образни методи за диагностика в съвременната медицина. Варненски медицински форум. 2016;5 (Прил. 4).

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