Abstract
Background: Renal stones (nephrolithiasis and urolithiasis) and nephrocalcinosis are uncommon in children; however, their incidences in pediatric populations have been increasing.Patients and Methods: This multicenter retrospective study compared the clinical presentation, etiology, and outcomes of childhood nephrolithiasis or urolithiasis with those of nephrocalcinosis.Results: The study included 144 children: 93 with renal stones and 51 with nephrocalcinosis. The mean age at presentation was 72 months and 54 months for children with renal stones and nephrocalcinosis, respectively. A history of consanguinity was found in 65% and 76% of the cases of renal stones and nephrocalcinosis, respectively. Congenital anomalies of the kidneys and urinary tract (CAKUT) were present in 28 and 9.8% of the patients with renal stones and nephrocalcinosis, respectively. The most common symptoms of renal stones were flank pain (29%), hematuria (15%), and dysuria (11%). Urinary tract infection was the primary presentation in the nephrocalcinosis group (18%), followed by failure to thrive (16%), polyuria (12%), and dehydration (12%). The majority of renal stone cases were caused by metabolic disorders, including hyperoxaluria (18%), cystinuria (18%), hypercalciuria (12%), and hyperuricosuria (2%). In contrast, the most common underlying disorders in cases of nephrocalcinosis were familial hypomagnesemia, hypercalciuria, nephrocalcinosis (35%), distal renal tubular acidosis (23%), and Bartter syndrome (6%). Clinical outcomes were significantly better in children with nephrolithiasis/urolithiasis than in those with nephrocalcinosis, who showed radiological evidence of worsening/persistent calcinosis and progressed more frequently to chronic kidney disease (stage II-IV) and end-stage kidney disease.Conclusion: The average age at presentation for children with renal stones was greater than that for those presenting with nephrocalcinosis. More than 25% of the children with renal stones were found to have CAKUT. Nephrocalcinosis was associated with worse clinical outcomes related to kidney function and disease resolution than nephrolithiasis.
Highlights
Nephrolithiasis refers to the presence of stones within the renal pelvis, while urolithiasis refers to stones in the kidney that are localized within the tubular lumen and lower urinary tract or primary bladder stones [1, 2]
We identified 144 patients who met the inclusion criteria (93 presented mainly with nephrolithiasis/urolithiasis and 51 with nephrocalcinosis)
We found that clinical outcomes were better in children with renal stones, children with nephrocalcinosis showed radiological evidence of worsening of the disease
Summary
Nephrolithiasis refers to the presence of stones within the renal pelvis, while urolithiasis refers to stones in the kidney that are localized within the tubular lumen and lower urinary tract or primary bladder stones [1, 2]. All three entities (nephrolithiasis, urolithiasis, and nephrocalcinosis) are relatively uncommon in the pediatric population; cases of these entities in children are increasing [3] and are becoming increasingly common causes for hospital admission or visits to renal clinics. The annual incidence of pediatric nephrolithiasis has increased from 6 to 10% over the past 20 years in the United States [3], with the greatest increase observed among adolescent black girls [4]. The etiology of this condition is metabolic in most children, with hematuria and urinary tract infections being the most common presentations [5]. Renal stones (nephrolithiasis and urolithiasis) and nephrocalcinosis are uncommon in children; their incidences in pediatric populations have been increasing
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