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Good Morning and Welcome Applicants!

Good Morning and Welcome Applicants!. January 27, 2011. Epidemiology . 1/685 pediatric admissions Lower incidence than adults Higher crystal formation inhibitors in urine M>F Most common stones Calcium oxalate Calcium phosphate Struvite Cystine Uric Acid. Risk Factors.

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Good Morning and Welcome Applicants!

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  1. Good Morning and Welcome Applicants! January 27, 2011

  2. Epidemiology • 1/685 pediatric admissions • Lower incidence than adults • Higher crystal formation inhibitors in urine • M>F • Most common stones • Calcium oxalate • Calcium phosphate • Struvite • Cystine • Uric Acid

  3. Risk Factors • Present in 75-85% of children • Urinary metabolic abnormality • Hypercalciuria* • Hyperoxaluria • Hyperuricosuria • Hypocitraturia • UTI • Structural renal or urinary tract abnormality

  4. Nephrolithiasis Presentation • Abdominal or flank pain • Wide variability • Gross hematuria • Dysuria • Urgency • Nausea/vomiting • 15-20% asymptomatic • Younger patients

  5. Other History • Previous history • Family history • Underlying renal and urinary tract structural abnormalities • Underlying metabolic conditions • Medication use • History of UTI • Especially with urease-producing organisms • Proteus or Klebsiella

  6. Physical Exam • Growth parameters • Congenital or chronic condition • Temperature • UTI • Blood pressure • Glomerular disease • Edema • Abdomen • Tenderness • Mass • Obstruction

  7. Lab Evaluation • UA • Sediment • Cystine crystals • Calcium oxalate • Calcium phosphate • Uric acid • Phosphate • Urine Culture

  8. Diagnosis • Confirmation • Imaging • Non-contrast helical CT • Ultrasonography • Stones >5mm • Location • Plain abdominal radiography • Radiopaque only • Not good for small stones • Retrieval

  9. Treatment • Hospitalization • Nausea/vomiting • Severe pain • Urinary obstruction • Solitary kidney • Infection

  10. Treatment • Pain control • NSAIDs • Opiod therapy • Combination may be superior • Passage • <5 mm • Hydration • Strain urine • Stone analysis

  11. Treatment • Urologic intervention • Unremitting severe pain • Urinary obstruction • Infection • Renal insufficiency • >5mm stone • Struvite calculi • >2 weeks of conservative treatment

  12. Treatment • Urological intervention • Extracorporeal shock wave lithotripsy • Small <1cm • Percutaneousnephrostolithotomy • >2cm • Structural abnormalities • Harder stones • Ureteroscopy

  13. Prevention • Recurrent stone disease frequently occurs in children • >50% of children with nephrolithiasis will have an underlying metabolic abnormality • Reduce • Pain • School absenteeism • Loss of work for parents • Clinical costs

  14. Prevention • Stone analysis • Focus metabolic evaluation • Metabolic evaluation • At home • Fully ambulatory • Regular diet • Free of infection

  15. Prevention • Serum testing • Calcium • Phosphorus • Bicarbonate • Creatinine • Magnesium • Uric Acid

  16. Prevention • UA • SpGr • pH • Crystals • Urine solute excretion • 24h vs single • Volume and creatinine

  17. Prevention • Fluid intake • Metabolic interventions • Targeted to correct the specific abnormality

  18. Monitoring • Imaging • New formation or increasing size of previous stones • U/S • Frequency depends on risk • Lab eval • Assess response to preventative therapy • 6-8 weeks, 6 months, yearly

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