Urolithiasis in children

"Urolithiasis" ("renal stone disease", "urolithiasis" and "nephrolithiasis") are terms that define 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 manifests itself in the presence of a stone in the urinary system or the passage of a stone.

Urinary stones (calculi) are unusually hard, insoluble substances that form in the straight urinary tubule system of the kidneys.

ICD-10 codes

• N20. Kidney and ureter stones.
• N20.0. Kidney stones.
• N20.1. Ureteral stones.
• N20.2. Kidney stones with ureteral stones.
• N20.9. Urinary stones, unspecified.
• N21. Stones of the lower urinary tract.
• N21.0. Bladder stones (excludes: staghorn calculi).
• N21.1. Stones in the urethra.
• N21.8. Other stones in the lower urinary tract.
• N21.9. Stones in lower urinary tract, unspecified.
• N22. Urinary tract stones in diseases classified elsewhere.
• N23. Renal colic, unspecified.

Epidemiology of urolithiasis

Urolithiasis is one of the most common urological diseases with pronounced endemicity. The proportion of urolithiasis among other urological diseases is 25-45%. Endemic areas for urolithiasis include a number of countries in North and South America, Africa, Europe and Australia. Urolithiasis annually affects 0.1% of the world's population. On our continent, urolithiasis is most often observed among the population of Kazakhstan, Central Asia, the North Caucasus, the Volga region, the Urals, and the Far North. In endemic areas, urolithiasis is also highly prevalent in children. According to many authors, urolithiasis in children accounts for 54.7% of all urological diseases in childhood in Tajikistan and 15.3% of the total number of patients with urinary system diseases in Georgia. In Kazakhstan, urolithiasis in children accounts for 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 and ureter stones are detected less often, and bladder stones - more often. Stones are found in the right kidney more often than in the left. 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 detected 2-3 times more often in boys.

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Causes of urolithiasis

There is no single theory of the etiology of urolithiasis, since in each specific case it is possible to identify its own factors (or groups of factors) and diseases that led to the development of metabolic disorders, such as hyperuricosuria, hypercalciuria, hyperoxaluria, hyperphosphaturia, changes in urine acidification, and the occurrence of urolithiasis. In the occurrence of these metabolic shifts, some authors attribute the leading role to exogenous factors, while others attribute it to endogenous causes.

Causes and pathogenesis of urolithiasis

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Symptoms of urolithiasis

Kidney stones may be asymptomatic and discovered as an incidental finding on an X-ray or ultrasound examination of the kidneys, which is often done for other reasons. They may also present as a dull ache in the side at the back. The classic symptom of kidney stones is intermittent, excruciating pain; if the stones are located in the right kidney, pain in the right side may occur. It begins in the lumbar region at the back, then spreads forward and down to the abdomen, groin, genitals, and medial thigh. Vomiting, nausea, increased sweating, and general weakness are also possible.

Symptoms of urolithiasis

Classification of urolithiasis

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

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Diagnosis of urolithiasis

The urinary sediment is examined, paying particular attention to the salt crystals. Calcium oxalate monohydrate crystals are oval in shape and resemble red blood cells. Calcium oxalate dihydrate crystals are pyramidal in shape and resemble an envelope. Calcium phosphate crystals are too small to be seen with a normal light microscope and resemble amorphous fragments. Uric acid crystals also usually resemble amorphous fragments, but they are typically yellow-brown in color.

Diagnosis of urolithiasis

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Treatment of urolithiasis

Treatment and prevention of urolithiasis in children and adults remains a difficult task. Treatment of patients with urolithiasis can be conservative and surgical. As a rule, complex treatment is carried out.

Conservative treatment is aimed at correcting biochemical changes in the blood and urine, eliminating pain and inflammation, preventing relapses and complications of the disease, and also promotes the passage of small stones up to 5 mm. Conservative treatment is indicated mainly in cases where the stone does not cause a violation of the outflow of urine, hydronephrotic 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 carried out in the presence of contraindications to surgical treatment of nephroureterolithiasis.

How is urolithiasis treated?

Prevention of urolithiasis

There are several stages of prevention: primary prevention of urolithiasis in children with a burdened heredity, in the presence of risk factors for the development of urolithiasis, metabolic nephropathy, the outcome of which in some cases can be urolithiasis. The basis of primary prevention of urolithiasis is non-drug therapy and, above all, an increased fluid regime and dietary recommendations taking into account the type of metabolic disorder. For example, in case of dysmetabolic nephropathy with oxalate-calcium crystalluria, a cabbage-potato diet is prescribed. And only in the absence of the effect of non-drug therapy, drugs are used taking into account the type of metabolic disorder or identified risk factors. In case of absorptive hypercalciuria, the use of calcium-containing products is limited, thiazide diuretics are used. In case of dysmetabolic nephropathy, antioxidants and membrane-stabilizing substances are prescribed - vitamins B6 _, A and E, xydiphone, dimephosphone, as well as herbal preparations that prevent crystal formation in urine, with anti-inflammatory and antioxidant properties (kanefron H, cyston, fitoren, etc.).

For secondary prevention of recurrent stone formation (metaphylaxis), in addition to non-drug therapy, drugs are used. In addition, drugs are prescribed that allow maintaining the optimal pH level in accordance with the type of metabolic disorder (blemaren, uralit, citrate mixture, etc.), litholytic drugs such as canephron N, cyston, phytoren, kedzhibiling leaves, prolit, phytolysin, cystenal, spazmocystenal, urolesan, madder extract, avisan, pinabin, etc. are prescribed in courses 2 times a year.

Sanatorium and spa treatment plays an important role in the complex treatment of patients with urolithiasis and the prevention of recurrent stone formation. Mineral waters increase diuresis, allow changing the pH of urine and its electrolyte composition. Sanatorium and spa treatment is advisable to recommend after the passage of a stone or its surgical removal with satisfactory renal function and sufficient dynamics of emptying the renal pelvis and ureter.