Identifying the cause of urolithiasis is the key to managing and preventing the complications of kidney stone disease. Recurrence is a common feature of UL and is influenced by genetic, environmental, dietary and socioeconomic factors. Lack of treatment may lead to recurrence in 50% of patients within 7 years of the initial stone diagnosis. This recurrence is highly associated with surgical interventions and dietary modifications. Despite the widespread detection of UR, a better understanding of its etiology and prevention strategies are needed.
Pediatric urolithiasis is a clinically significant condition, related to a significant morbidity. It has been estimated that the prevalence of urolithiasis is between 1% and 5%, which is significantly lower than the prevalence of adult stone disease. In addition, it is associated with a multi-effect on patients’ quality of life. The most common clinical presentations of pediatric urolithiasis are dysuria and urinary tract infection. However, some children present with no classic symptoms of renal colic. In fact, an estimated 10% of children with pediatric UL have signs of lower urinary tract dysfunction.
Pediatric urolithiasis can be caused by intrinsic factors or environmental factors. Environmental factors may include temperature and climate, genetics, dietary intake, and water intake. Genetic factors may predispose a child to developing UL. Other factors, such as family history and age, also play a role in the risk for UR. In addition, pediatric urolithiasis may occur as an incidental finding during an imaging workup.
This study evaluated the accuracy of unenhanced computerized tomography (CT) for detecting renal calculi in children with urolithiasis symptoms. It was determined that CT was highly accurate in all conditions and was more accurate in children with urolithiasis-related symptoms than in those without. It was also determined that ultrasound was more variable than CT in children with urolithiasis-related symptomatology.
Pediatric urolithiasis symptoms included abdominal or flank pain, hematuria, urinary tract infection, and dysuria. In addition, most children with pediatric urolithiasis symptoms had an increased risk of recurrence. This increased risk was related to family history and age. It was also found that recurrence was significantly associated with dietary factors and genetics. However, it was also found that a health education program was effective in preventing recurrence. The study results highlight the need for a continuous health education program and emphasize the importance of practicing good dietary intake.
The study also evaluated the accuracy of CT and ultrasound for detecting calculi in children with urolithiasis-related pain. Ultrasound was more variable than CT in children with ureteral stones and calculi. It was also found that ultrasound failed to detect calculi in 41% of children with urolithiasis-related signs and symptoms. It was also found that ultrasound was not able to detect urolithiasis in 15% of children with urolithiasis-related discomfort.
Another study evaluated the accuracy of ultrasound and CT in children with microlithiasis. In this study, 292 children with microlithiasis were evaluated. It was found that the mean age of children with microlithiasis was 16.8+- 14.9 months. It was also found that the mean follow-up duration was 14.6+- 5.9 months. The study found that ultrasound was not able to detect calculi in 41% of children, and CT was more accurate in all situations.
