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PAEDIATRIC NEPHROLITHIASIS

BACKGROUND

Stone disease in children is uncommon and stone formation is often associated with metabolic disorders, chro­nic infections and/or morphological anomalies of the urinary tract. Recurrence rate is only high in cases of metabolic disorders and may be the initial manifestation of a congenital and subsequently chronic disease. It is important to realize that stone formation is not a disease in itself, but a consequence of an underlying disorder. Treatment of paediatric nephrolithiasis must therefore comprise a strategy to clear the actual stone burden reliably, diagnose and, ideally, eliminate the underlying pathology. Effective measures should be taken to prevent recurrent disease.

DIAGNOSIS

Children are considered to be high-risk patients and need a full metabolic work up. The patient's history is particularly important as many metabolic disorders are hereditary [e.g. autosomal recessive disorders (cystinuria, primary hyperoxaluria, 2,8-dihydroxyadenine and xanthine calculi); autosomal dominant disorders (renal tubular acidosis, idiopathic hypercalciuria)]. In cases of a positive family history, an unfavourable clinical course has to be reckoned with.

In children, hypercalciuria with hypercalcaemia is frequently caused by immobilization (e.g. during fracture treatment). Another rare condition is hyperparathyroidism. As stone formation only occurs in a subset of immobilized children, a complete metabolic work up should be performed, as other metabolic disorders may facilitate the manifestation.

It must also be emphasized that the normal values of the excretion rate of lithogenous and inhibitory agents in adults cannot be applied to children, but requires correction for body weight (mmol/kg/d) as below. Variation between laboratories must also be considered.