Urolithiasis in children

"Urolithiasis" ("nephrolithiasis", "urolithiasis" and "nephrolithiasis") are terms that determine the clinical syndrome of the formation and movement of stones in the urinary system.

Urolithiasis is a disease caused by a metabolic disorder associated with various endogenous and / or exogenous causes, which is often hereditary and is manifested by the presence of a stone in the urinary system or the removal of a stone.

Urinary stones (concretions) are unusually solid, insoluble substances formed in the system of the rectal urinary canaliculi of the kidneys.

ICD-10 codes

• N20. Stones of the kidney and ureter.
• N20.0. Kidney stones.
• N20.1. Stones of the ureter.
• N20.2. Kidney stones with ureteral stones.
• N20.9. Urinary stones, unspecified.
• N21. Stones of the lower parts of the urinary tract.
• N21.0. Stones in the bladder (excluding: coral concretions).
• N21.1. Stones in the urethra.
• N21.8. Other stones in the lower parts of the urinary tract.
• N21.9. Stones in the lower parts of the urinary tract, unspecified.
• N22. Stones of the urinary tract in diseases classified elsewhere.
• N23. Renal colic, unspecified.

Epidemiology of urolithiasis

Urolithiasis is one of the most common urological diseases with pronounced endemicity. The specific gravity of urolithiasis among other urological diseases is 25-45%. A number of countries in North and South America, Africa, Europe and Australia consider endemic areas of urolithiasis. Urolithiasis affects 0.1% of the world's population every year. On our continent, most often urolithiasis is observed among the population of Kazakhstan, Central Asia, the North Caucasus, the Volga region, the Urals, the Far North. In endemic areas, there is a high prevalence of urolithiasis in children. According to many authors, urolithiasis in children in Tajikistan is 54.7% of all urological diseases of childhood, in Georgia - 15.3% of the total number of all patients with diseases of the urinary system. In Kazakhstan, urolithiasis in children is 2.6% of all surgical patients and 18.6% of the total number of urological patients.

Urolithiasis occurs at any age, but in children and the elderly, kidney stones and ureters are less common, and bladder stones are more common. In the right kidney, stones are found more often than in the left kidney. Bilateral kidney stones in children are observed in 2.2-20.2%. In adults - in 15-20% of cases. Urolithiasis is recorded in children of all age groups, including newborns, but more often at the age of 3-11 years. In children, urolithiasis is found 2-3 times more often in boys.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Causes of urolithiasis

There is no unified theory of the etiology of urolithiasis, since in each specific case it is possible to identify factors (or groups of factors) and diseases that have led to the development of metabolic disorders such as hyperuriculia, hypercalcuria, hyperoxaluria, hyperphosphaturia, changes in urinary acidification, and the occurrence of urolithiasis. In the occurrence of these metabolic shifts, some authors take the leading role exogenous factors, others - endogenous reasons.

Causes and pathogenesis of urolithiasis

[10], [11], [12], [13], [14]

Symptoms of urolithiasis

Kidney stones can be asymptomatic and can be detected as an accidental finding on an X-ray or ultrasound examination of the kidneys, which is often done for other reasons. They can also show dull pain in the side from behind. A classic symptom of kidney stones is a periodical painful pain, with the localization of stones in the right kidney, pain in the right side may occur . It starts in the lumbar region from behind, then spreads anteriorly and downward to the abdomen, into the groin, the genitals and the medial part of the thigh. Vomiting, nausea, increased sweating and general weakness are also possible.

Symptoms of urolithiasis

Classification of urolithiasis

• By localization in the organs of the urinary system:
  • in the kidneys (nephrolithiasis);
  • ureters (ureterolithiasis);
  • urinary bladder (cystolithiasis).
• By type of stones:
  • urates;
  • phosphates;
  • oxalates:
  • cystine stones, etc.
• In the course of the disease:
  • primary formation of stones;
  • recurrent (repeated) formation of stones.
• Special forms of urolithiasis:
  • coral stones of the kidneys;
  • stones of a single kidney;
  • urolithiasis in pregnant women.

[15], [16], [17], [18], [19], [20], [21]

Diagnosis of urolithiasis

Examine the urine sediment, paying special attention to salt crystals. Crystals of oval calcium oxalate monohydrate are similar to erythrocytes. The crystals of calcium oxalate dihydrate are pyramidal in shape and resemble an envelope. Calcium phosphate crystals are too small to be detected in a conventional light microscope and are similar to amorphous fragments. Crystals of uric acid also usually resemble amorphous fragments, but they are characterized by a yellow-brown color.

Diagnosis of urolithiasis

[22], [23], [24], [25], [26], [27], [28]

Treatment of urolithiasis

Treatment and prevention of urolithiasis in children and adults remains a difficult task. Treatment of patients with nephrolithiasis can be conservative and operative. As a rule, they carry out complex treatment.

Conservative treatment is aimed at correction of biochemical changes in blood and urine, elimination of pain and inflammation, prevention of recurrences and complications of the disease, and also contributes to the removal of small stones up to 5 mm. Conservative treatment is shown mainly in those cases when the calculus does not cause a violation of urinary outflow, hydronephrosis transformation or shrinkage of the kidney as a result of the inflammatory process, for example, with small stones in the renal calyces. Conservative therapy is also performed in the presence of contraindications to the surgical treatment of nephroureterolithiasis.

How is urolithiasis treated?

Prevention of urolithiasis

There are several stages of prevention: primary prevention of urolithiasis in children with hereditary heredity, with risk factors for urolithiasis, exchange nephropathy, the outcome of which in some cases may be urolithiasis. The basis of primary prevention of urolithiasis is drug-free therapy and, above all, increased drinking regimen and dietary recommendations, taking into account the variant of metabolic disorders. For example, with dismetabolic nephropathy with oxalate-calcium crystalluria, a cabbage-potato diet is prescribed. And only in the absence of the effect of drug-free therapy, drugs are used, taking into account the variant of metabolic disturbance or identified risk factors. Absorptive hypercalciuria restrict the use of products containing calcium, use thiazide diuretics. With dismetabolic nephropathy antioxidants and membrane stabilizing substances - vitamins B ₆, A and E, xidiphon, dimephosphonum are prescribed. As well as phytopreparations that prevent crystal formation in the urine, which have anti-inflammatory and antioxidant properties (kanefron H, cystone, phytorene, etc.).

For secondary prevention of recurrence of stone formation (metaphylaxis), in addition to drug-free medication, medicines are used. In addition, prescribe drugs that allow to maintain the optimal pH level in accordance with the variant of metabolic disorders (blemaren, uralit, citrate mixture, etc.), courses 2 times a year, litholytic drugs such as kanefron H, cystone, phytoren, kedibilin leaves, shed, phytolysin, cystenal, spasmocystenal, urolesan, madder extract of dyeing, avisan, pinabine, etc. If a patient has a urinary infection, treatment is prescribed and measures are taken to prevent relapses.

Sanatorium-and-spa treatment plays an important role in the complex treatment of patients with urolithiasis and the prevention of recurrent stone formation. Mineral water increases diuresis, allows you to change the pH of urine and its electrolyte composition. It is advisable to recommend sanatorium treatment after the removal of the stone or its removal by surgery with satisfactory renal function and sufficient dynamics of emptying the pelvis and ureter.