medigraphic.com
ISSN 1527-3172 (Electronic)

2021, Number 1

<< Back Next >>

MEDICC Review 2021; 23 (1)

Urinary Metabolic Disorders Associated with Urolithiasis in Cuban Pediatric Patients

Bacallao-Méndez RA, Mañalich-Comas R, Gutiérrez-García F, Madrid-Mancia CF, Lucero-Méndez C, Smith-González MJ

Language: English
References: 49
Page: 43-48
PDF size: 163.78 Kb.


ABSTRACT

INTRODUCTION Pediatric urinary lithiasis (urolithiasis) is an important health issue linked to urinary metabolic disorders. In the United States alone, annual costs associated with urolithiasis are $229 million for hospital admissions and $146 million for emergency care.
OBJECTIVE Identify urinary metabolic disorders in Cuban pediatric patients with urolithiasis and better understand the relationship of age, demographic and anthropometric variables to urinary metabolic disorders strongly associated with urolithiasis.
METHODS We carried out a descriptive, cross-sectional study. The study universe was comprised of Cuban patients aged 2 to 19 years with urinary lithiasis who underwent renal metabolic studies at the Dr Abelardo Buch López Nephrology Institute in Havana, Cuba, from 2008 through 2019. All data were obtained from reports of the aforementioned metabolic studies. We collected the following variables: age, sex, nutritional status, urinary volume, plasma and urinary creatine concentrations; and calcium, uric acid, oxalate and citrate urinary excretions collected during a 24-hour period. We included results of urinary cystine tests and urine mini-cultures. We obtained frequency distributions for categorical and qualitative variables and calculated means and standard deviations for quantitative variables. We also evaluated homogeneity of metabolic disorders between children and adolescents.
RESULTS We studied 1592 pediatric patients, of whom 67.7% (1078/1592) were adolescents. The main metabolic disorders included hypercalciuria (39.1%; 622/1592), decreased urinary fl ow (22.4%; 357/1592) and hypocitraturia (18.2%; 289/1592). Hypercalciuria, hypocitraturia and hyperoxaluria were more common in children, while decreased urinary fl ow and hyperuricosuria were more common in adolescents. Hyperuricosuria was more frequent in male patients (6.3%; 40/639 vs. 1.8%; 8/439) and had the greatest impact on lithogenesis. Hypercalciuria was more frequent in undernourished children (62.5%; 30/48) than in overweight children (21.7%; 10/46), or those with obesity (33.3%; 15/45).
CONCLUSIONS The main metabolic disorders among Cuban pediatric patients with urinary lithiasis are: hypercalciuria, decreased urinary flow and hypocitraturia. Hypercalciuria, hypocitraturia and hyperoxaluria are more common in children, and decreased urinary fl ow and hyperuricosuria are more common in adolescents. Identifying urinary metabolic disorders facilitates formulation of treatment plans tailored to decreasing the likelihood of urolithiasis.


REFERENCES

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

  2. Van Dervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol. 2007 Jun;177(6):2300–5.

  3. Pong YH, Huang WY, Lu YC, Tsai VF, Chen YF, Chang HC, et al. Temporal trend of newly diagnosed incidence, medical utilization, and costs for pediatric urolithiasis, 1998-2007: a nationwide population-based study in Taiwan. Urology. 2015 Jan;85(1):216–20.

  4. Schwaderer AL, Cronin R, Mahan JD, Bates CM. Low bone density in children with hypercalciuria and/or nephrolithiasis. Pediatr Nephrol. 2008 Dec;23(12):2209–14.

  5. Routh JC, Graham DA, Nelson CP. Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals. J Urol. 2010 Sep;184(3):1100–4.

  6. Pietrow PK, Pope JC 4th, Adams MC, Shyr Y, Brock JW 3rd. Clinical outcome of pediatric stone disease. J Urol. 2002 Feb;167(2 Pt 1):670–3.

  7. Wang HHS, Wiener JS, Lipkin ME, Scales CD Jr, Ross SS, Routh JC. Estimating the nationwide, hospital based economic impact of pediatric urolithiasis. J Urol. 2015 May;193(5 Suppl):1855–9.

  8. 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 Jul;23(7):1129–33.

  9. Velásquez-Forero F, Esparza M, Salas A, Medeiros M, Toussaint G, Llach F. Risk factors evaluation for urolithiasis among children. Bol Med Hosp Infant Mex. 2016 Jul–Aug;73(4):228 –36.

  10. Amancio L, Fedrizzi M, Bresolin NL, Penido MGMG. [Pediatric urolithiasis: experience at a tertiary care pediatric hospital. J Bras Nefrol] [Internet]. 2016 Jan–Mar [cited 2020 Mar 7];38(1):90–8. Available at: http://www.scielo .br/scielo.php?script=sci_arttext&pid=S0101 -28002016000100090&lng=en. Portuguese.

  11. Funes P, Echagüe G, Ruiz I, Rivas L, Zenteno J, Guillén R. Perfi l de riesgo litogénico en pacientes con urolitiasis en Paraguay. Rev Méd Chile. 2016 Jun;144(6):716–22. Spanish.

  12. Berdasco A, Esquivel M, Gutiérrez JA, Jiménez JM, Mesa D, Posada E, et al. Segundo estudio nacional de crecimiento y desarrollo. Cuba, 1982: valores del peso y talla para la edad. Rev Cubana Pediatr. 1991 Jan–Apr;63(1):4–21. Spanish.

  13. Esquivel M, Rubí A. Valores cubanos del índice de masa corporal en niños y adolescentes de 0 a 19 años. Rev Cubana Pediatr. 1991 May –Aug;63(3):181–90. Spanish.

  14. Dubois D, Dubois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989 Sep–Oct;5(5):303–11.

  15. Badell Moore A, Bacallao Méndez RA, Mañalich Comas R. Sobre el establecimiento de valores de referencia de la excreción de creatinina para la población cubana. Rev Cubana Aliment Nutr. 2015 Jan–Jun;25(1 Suppl 1):S28–S60. Spanish.

  16. Hoppe B, Kemper MJ. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol. 2010 Mar;25(3):403–13.

  17. Durán Álvarez S. Urolitiasis en el niño. Rev Cubana Pediatr. 2013 Jul–Sep;85(3):371–85. Spanish.

  18. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017 Sep;35(9):1301–20.

  19. Bacallao Méndez RA, Victores Aguiar I, Mañalich Comas R, Gutiérrez García F, Llerena Ferrer B, Almaguer López M. Caracterización clínico epidemiológica de la litiasis urinaria en un área rural de Artemisa. Rev Cubana Invest Bioméd. 2016 Oct–Dec;35(4):300–10. Spanish.

  20. Cameron MA, Sakhaee K, Moe OW. Nephrolithiasis in children. Pediatr Nephrol. 2005 Nov;20(11):1587–92.

  21. Seitz C, Fajkovic H. Epidemiological genderspecifi c aspects in urolithiasis. World J Urol. 2013 Oct;31(5):1087–92.

  22. Coward RJM, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child. 2003 Nov;88(11):962–5.

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

  24. Chan KH, Moser EA, Whittam BM, Misseri R, Cain MP, Krambeck A, et al. Initial collection of an inadequate 24-hour urine sample in children does not predict subsequent inadequate collections. J Pediatr Urol [Internet]. 2019 Feb [cited 2020 Mar 17];15(1):74.e1–74.e7. Available at: http://www.sciencedirect.com/science/article/ abs/pii/S1477513118306387

  25. Besouw MTP, Bienias M, Walsh P, Kleta R, Van’t Hoff WG, Ashton E, et al. Clinical and molecular aspects of distal renal tubular acidosis in children. Pediatr Nephrol. 2017 Jun;32(6):987–96.

  26. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 populationbased measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017 Dec 16;390(10113):2627–42.

  27. El-Zoghby ZM, Lieske JC, Foley RN, Bergstralh EJ, Li X, Melton LJ 3rd, et al. Urolithiasis and the Risk of ESRD. Clin J Am Soc Nephrol. 2012 Sep;7(9):1409–15.

  28. Bacallao Méndez RA, Madrid Mancia C, Mañalich Comas R, Gutiérrez García F, Badell Moore A. Trastornos metabólicos renales en pacientes cubanos adultos con litiasis urinarias. Rev Cubana Med. 2014 Sep–Dec;53(4):456–67. Spanish.

  29. Spivacow FR, Negri AL, del Valle EE, Calvino I, Zanchetta JR. Clinical and metabolic risk factor evaluation in young adults with kidney stones. Int Urol Nephrol. 2010 Jun;42(2):471–5.

  30. Celiksoy MH, Yilmaz A, Aydogan G, Kiyak A, Topal E, Sander S. Metabolic disorders in Turkish children with urolithiasis. Urology. 2015 Apr;85(4):909–13.

  31. Yang D, Tiselius HG, Lan C, Chen D, Chen K, Ou L, et al. Metabolic disturbances in Chinese children with urolithiasis: a single center report. Urolithiasis. 2017 Jun;45(3):285–90.

  32. Sepahi MA, Eftekhari SS, Shahmoradi S, Talebizadeh M, Rashidinia S, Hejazi SS. Metabolic and anatomic abnormalities associated with pediatric nephrolithiasis: a cross-sectional study. Int J Pediatr. 2017 May;5(5):4833–8.

  33. Cambareri GM, Kovacevic L, Bayne AP, Giel D, Corbett S, Schurtz E, et al. National multi-institutional cooperative on urolithiasis in children: age is a signifi cant predictor of urine abnormalities. J Pediatr Urol. 2015 Aug;11(4):218–23.

  34. Kant AK, Graubard BI. Contributors of water intake in US children and adolescents: associations with dietary and meal characteristics - National Health and Nutrition Examination Survey 2005-2006. Am J Clin Nutr. 2010 Oct;92(4):887–96.

  35. Kubota M. Hyperuricemia in children and adolescents: present knowledge and future directions. J Nutr Metab [Internet]. 2019 May 2 [cited 2020 Mar 17];2019:Art ID 3480718. Available at: https:// www.hindawi.com/journals/jnme/2019/3480718/

  36. Shatat IF, Abdallah RT, Sas DJ, Hailpern SM. Serum uric acid in U.S. adolescents: distribution and relationship to demographic characteristics and cardiovascular risk factors. Pediatr Res. 2012 Jul;72(1):95–100.

  37. Bergsland KJ, Coe FL, White MD, Erhard MJ, DeFoor WR, Mahan JD. Urine risk factors in children with calcium kidney stones and their siblings. Kidney Int. 2012 Jun;81(11):1140–8.

  38. Butani L, Kalia A. Idiopathic hypercalciuria in children how valid are the existing diagnostic criteria? Pediatr Nephrol. 2004 Jun;19(6):577–82.

  39. Kirejczyk JK, Porowski T, Konstantynowicz J, Kozerska A, Nazarkiewicz A, Hoppe B, et al. Urinary citrate excretion in healthy children depends on age and gender. Pediatr Nephrol. 2014 Sep;29(9):1575–82.

  40. Kovacevic L, Wolfe-Christensen C, Edwards L, Sadaps M, Lakshmanan Y. From hypercalciuria to hypocitraturia a shifting trend in pediatric urolithiasis? J Urol. 2012 Oct;188(4 Suppl):1623–7.

  41. Saxena A, Sharma RK. Nutritional aspect of nephrolithiasis. Indian J Urol. 2010 Oct;26(4):523–30.

  42. Daga A, Majmundar AJ, Braun DA, Gee HY, Lawson JA, Shril S, et al. Whole exome sequencing frequently detects a monogenic cause in early onset nephrolithiasis and nephrocalcinosis. Kidney Int. 2018 Jan;93(1):204–13.

  43. Copelovitch L. Urolithiasis in children. Pediatr Clin North Am. 2012 Aug;59(4):881–96.

  44. Shavit L, Ferraro PM, Johri N, Robertson W, Walsh SB, Moochhala S, et al. Effect of being overweight on urinary metabolic risk factors for kidney stone formation. Nephrol Dial Transplant. 2015 Apr;30(4):607–13.

  45. Kokorowski PJ, Routh JC, Hubert KC, Graham DA, Nelson CP. Association of urolithiasis with systemic conditions among pediatric patients at children’s hospitals. J Urol. 2012 Oct;188(4 Suppl):1618–22.

  46. Sarica K, Eryildirim B, Yencilek F, Kuyumcuoglu U. Role of overweight status on stone-forming risk factors in children: a prospective study. Urology. 2009 May;73(5):1003–7.

  47. Bacallao Méndez RA, Mañalich Comas R, Gutiérrez García F, Badell Moore A, Caldevilla Rodríguez Y. pH urinario y estado nutricional en pacientes cubanos con urolitiasis. Rev Cubana Med. 2015;54(2):119–28. Spanish.

  48. Murphy MO, Erpelding SG, Chishti AS, Dugan A, Ziadab A, Kiessling SG. Infl uence of BMI in nephrolithiasis in an Appalachian pediatric population: a single-center experience. J Pediatr Urol [Internet]. 2018 Aug [cited 2020 Mar 19];14(4):330. e1–330.e8. Available at: http://www.sciencedirect .com/science/article/pii/S1477513118301931

  49. Parks JH, Goldfi sher E, Asplin JR, Coe FL. A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis. J Urol. 2002 Apr;167(4):1607–12.




2020     |     www.medigraphic.com