Progressive Bilateral Childhood Urolithiasis of Rare Etiology: Ultrasound Images and Evidence-Based Therapeutic Recommendations.

Abstract

Background: Multiple, recurrent and bilateral renal stones causing progressive bilateral urolithiasis is rare during childhood and metabolic disorder such as cystinuria and oxalosis are commonly. The aim of this paper is to report the very rare presentation of hypercalciuria and hypercalciuria with progressive bilateral renal stone disease, with stones predominantly composed of ammonium and phosphate suggesting infective etiology. Patients and methods: A boy with progressive bilateral renal stone disease since early infancy and had been treated by several urologist during the previous three years was studied. He was first referred at the age of five years requesting the opinion about the use of medical therapies and therefore an evidence-based recommendation was made. Results: The boy was initially diagnosed as having bilateral urolithiasis at about the age of two years and during the previous three years with three surgical operations and two lithotripsy sessions. Stone were predominantly composed of ammonium (++++) and phosphate (++++), but they also contained calcium (+++) and uric acid (+). There was evidence of urinary infections with Klebsiella and Enterobacter species suggesting an infective etiology of the stone disease. On referral, Sodium nitroprusside test for cystine was negative and paper chromatography for cystine was also negative. 24-hour urine examination (volume 1600 ml): Calcium 264 mg/24 hr (more than 12 mg/kg/24hr) and oxalate 0.17 g/24 hr (Normal: 0.01-0.04 g /24). Conclusion: Urologists should make an early consultation with a pediatrician expert in renal disorders to provide the necessary medical therapies. Bilateral progressive renal stone disease is rarely caused by infective etiologies alone and the presence of recurrent urinary infections should not lead to ignoring the possibility of metabolic abnormalities.