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Infantile urolithiasis: Diagnosis

Author(s): M. Mehdizadah | J. Jannati

Journal: Iranian Journal of Radiology
ISSN 1735-1065

Volume: 3;
Issue: S1;
Start page: 1;
Date: 2005;
Original page

Introduction & Background: Urolithiasis in children is not a common disease in western countries. Urolithiasis in children is more located in the upper urinary tract and only 5-10% is seen in the bladder. The most com-mon stone composition differs in variable age groups but calcium oxalate seems to be the most common type in all children age groups. Clinical manifestations also differ in different age groups. In infants, growth retarda-tion (FTT) and crying during crystaluria are the most common symptoms and signs. High resolution (HR) sonography (7.5 MHz) is an effective, noninvasive, and easy to access procedure for the diagnosis of infantile urolithiasis. Even with high resolution sonography (7.5 MHz) we can determine the grading of nephrocalcino-sis in infants. Non radio-opaque stones are also diagnosed by HR sonography. Patients & Methods: This study tries to emphasize the importance and efficacy of high resolution sonography in the diagnosis of infantile urolithiasis by surveillance of 200 infants under 2 years old with urinary tract stones in Markaz-Tebi-Hospital during 1375 to 1383. Results: In this study the mean age was 12 months old (2 to 24 months) and 55% were boys; 61% had positive family history; 54.5% (109 ones) had no underlying metabolic disorder and among others 41 (20.5%) had hy-percalciuria ( the most common ); 78 (39%) had hematuria, 61 (30.5%) had pyuria and 61 (30.5%) had no ab-normality in U/A. In 63 (31.5%), urine culture was positive; 39 (31.5%) had macroscopic hematuria. Their chief complaint was changing of urine color in 44 (22%), crystaluria in 37 (18.5%), UTI in 37 (31%), and no complaints in 20 (10%). FTT and crying during urination were observed in 25 (12.5%) and 12 (6%) of our pa-tients. In 79.5% of all infants, there was a positive sonographic finding that confirmed the stone. About the stone location according to the sonographic finding, 124 (62%) had kidney stone, 10 (4.5%) had ureter stone, and 25 (12.5%) had bladder stone. In 31 patients (6.5%), stone composition was urate, in 48 (24%) it was cal-cium oxalate, in 5 (2.5%) it was cystine, and in 14 (7%) it was struvite. Among 63 infants with positive urine culture, 49 patients (30.8%) and among 137 infants with negative urine culture, 110 (69.2%) had positive sonographic findings. Among 39 infants with macroscopic hematuria, 35 (22%), and among 161 without mac-roscopic hematuria, 124 (78%) had positive sonographic findings. Among 124 infants with kidney stones, all of them (78%), among 34 patients with ureter stone only 10 (6.3%) and among 25 infants with bladder stone, all of them (15.7%) had positive sonographic findings. Among 13 infants with urate stone, 11 (6.9%), among 48 patients with oxalate stone, 39 (24.5%), among 5 infants with cystine stones, 4 (2.5%), among 14 with struvite stones, 12 (7.5%), and among 120 infants with undetermined stone composition, 93 (58.5%) had positive sonographic findings. Conclusion: According to the results of this study and based on the importance of diagnosis of infantile uro-lithiasis, it seems necessary or useful to do HR sonography (7.5 MHz) especially in infants with specific or non-specific symptoms of urolithiasis, infants with FTT with no good reason infants with recurrent UTI, infants with infantile errors of metabolism especially cystinuria, infants with proven urolithiasis during courses of treatment.
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