Öz
Amaç: Çocuklarda nefrolitiazis oluşumunda çevresel, genetik risk faktörleri ile metabolik bozuklukların de yer aldığı ve sıklığı gittikçe artan bir hastalık grubudur. En sık saptanan metabolik bozukluklar hiperkalsiüri ve hipositratüridir. Çalışmamızın amacı, Akdeniz bölgesindeki pediatrik yaş grubunda nefrolitiazisli hastaların başvuru tarihleri, demografik, metabolik ve klinik özelliklerini değerlendirerek risk faktörlerini belirlemektir.
Gereç ve Yöntem: Ocak 2015 ile Mart 2018 arasında hastanemiz çocuk nefroloji polikliniğinde nefrolitiazis tanısı almış 129 hasta (55 kız,74 erkek) çalışmaya alındı. Bu hastaların başvuru tarihleri, demografik parametreleri, klinik semptomları, metabolik ve radyolojik tetkikleri retrospektif olarak incelendi.
Bulgular: Toplam 129 hasta, 55’i kız (%42,6) ve 74’ü erkek (%57,4), yaş ortalaması 4,2±4,7 yıl idi. Hastaların %71,3’ünde tek taraflı, %24,8’inde ise iki taraflı renal yerleşimli taş saptandı. En sık görülen klinik semptom huzursuzluk, renal kolik ve hematüri idi. Metabolik değerlendirmeler incelendiğinde hastaların 39’unda hiperürikozüri, 29’unda hiperkalsiüri, 14’ünde hipositratüri ve hiperoksalüri, üçünde sistinüri saptandı. İdrar yolu enfeksiyonu 23 hastada tespit edilirken, 15 hastaya medikal tedaviye ek olarak cerrahi tedavi gerekli görüldü. Geliş tarihleri incelendiğinde hastaların büyük kısmının (%67,4’ü) sıcak mevsimlerde (ilkbahar ve yaz) başvurduğu ve tanı aldığı saptandı.
Sonuç: Sıcak iklimde yaşamanın, dehidratasyon nedeniyle böbrek taşı oluşma riskini arttırdığını düşünmekteyiz. Sıvı alımının yetersiz olması, infant grubunda, böbrek taşlarının büyümesini destekleyen idrar ürik asit ve kalsiyumun yüksek atılımına yol açmaktadır.
Anahtar Kelimeler
Kaynakça
- Clayton DB, Pope JC. The increasing pediatric stone disease problem. Ther Adv Urol 2011; 3: 3-12.
- Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 2010; 157, 132-7.
- Spivacow FR, Negri AL, del Valle EE, Calvino I, Fradinger E, Zanchetta JR, Metabolic risk factors in children with kidney stone disease, Pediatr Nephrol, 2008; 23: 1129-33.
- Baştuğ F, Gündüz Z, Tülpar S, Poyrazoğlu H, Düşünsel R, Urolithiasis in infants: evaluation of risk factors, World J Urol 2013; 31: 1117–22.
- Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, et al, Epidemiology of paediatric renal stone disease in the UK, Arch Dis Child 2003; 88: 962–5.
- Dursun I, Poyrazoglu HM, Dusunsel R, Gunduz Z, Gurgoze MK, Demirci D, et al. Pediatric urolithiasis: an 8-year experience of single centre, Int Urol Nephrol 2008; 40: 3–9
- Elder JS, Urinary lithiasis, In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Philadelphia: Saunders; 2008; 2267-72.
- Milliner DS, Urolithiasis, In: Avner ED, Harmon WE, Niaudet P, Pediatric nephrology, 5th ed, Philadelphia: Springer; 2009; p, 1405-1431.
- Alpay H, Gokce I, Ozen A, Bıyıklı N, Urinary stone disease in the first year of life: is it dangerous? Pediatr Surg Int 2013; 29: 311–316.
- Baştuğ F, Düşünsel R, Pediatric urolithiasis: causative factors, diagnosis and medical management, Nat Rev Urol 2012; 9: 138-146.
- Choi H, Synder HM, 3rd, Duckett JW, Urolithiasis in childhood: current management, J Pediatr Surg 1987; 22: 158–164,
- Miller LA,Stapleton FB, Urinary volume in children with urolithiasis, J Urol 1989;141: 918–920.
- Hoppe B, Leumann E, Milliner DS, Urolithiasis and nephrocalcinosis in childhood, In: Geary DF, Schaefer F (eds), Comprehensive Pediatric Nephrology, 1st edn, Mosby, Philadelphia, PA, 2008; 499-526.
- Poyrazoğlu HM, Düşünsel R, Yazici C, Durmaz H, Dursun I, Sahin H, et al, Urinary uric acid: creatinine ratios in healthy Turkish children, Pediatr Int 2009; 51: 526-529.
- Matos V, Van Melle G, Werner D, Bardy D, Guignard JP, Urinary oxalate and urate to creatinine ratios in a healthy pediatric population, Am J Kidney Dis 1999; 34:e1.
- Matos V, Van Melle G, Boulat O, Markert M, Bachmann C, Guignard JP, Urinary phosphate/creatinine, calcium/ creatinine, and magnesium/creatinine ratios in a healthy pediatric population, J Pediatr 1997;131:252-257.
- Habbig S, Beck BB, Hoppe B, Nephrocalcinosis and urolithiasis in children, Kidney Int 2011; 80: 1278-1291,
- Dinçel N, Özdemir K, Mir S, Demographic and Clinic Features of Children with Nephrolithiasis in Izmir, J Cont Med, 2012; 2: 77-81.
- Buttigieg J, Attard S, Carachi A, Galea R, Fava S, Nephrolithiasis, stone composition, meteorology, and seasons in Malta: Is there any connection? Urol Ann 2016; 8: 325-332,
- Sirohi M, Katz BF, Moreira DM, Dinlenc C, Monthly variations in urolithiasis presentations and their association with meteorologic factors in New York City, J Endourol 2014; 28: 599604.
- Baştuğ F, İnfantlarda Üriner Sistem Taş Hastalığı: Etyoloji ve Tedavi, Endoüroloji Bülteni 2013; 6: 143-151,
- Gillespie RS, Stapleton FB, Nephrolithiasis in Children, Pediatr Rev 2004; 25: 131–139.
- Afshin Safaei Asl, Shohreh Maleknejad, Pediatric Urolithiasis An Experience of a Single Center, Iranian Journal of Kidney Diseases 2011; 5: 309-313.
- Tiselius HG, Ackermann D, Alken P, Working Party on Lithiasis: European Association of Urology Guidelines on urolithiasis, Eur Urol 2001; 40: 362–71.
- Sternberg K, Greenfield SP, Williot P, Wan J, Pediatric stone disease: an evolving experience, J Urol 2005; 174: 1711–1714.
- Baysal YE, Koyun M, Akman S, Güven AG, Güntekin E, Çocuklarda ürolitiyazis: Antalya yöresinde 10 yıllık deneyim, Çoc Sağ ve Hast Der 2004; 47: 254-259.
- Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C, Guidelines on urolithiasis, Working Party on Lithiasis, European Association of Urology, 2012.
- Dursun İ, Ünsür EK, Çocuklarda üriner sistem taş hastalığına güncel yaklaşım, Çoc Cer Der 2016; 30: 146-155.
- Miyake O, Yoshimura K, Yoshioka T, Koide T, Okuyama A, High urinary excretion level of citrate and magnesium in children: potential etiology for the reduced incidence of pediatric urolithiasis, Urol Res 1998; 26: 209.
- Alpay H, Ozen A, Gokce I, Biyikli N, Clinical and metabolic features of urolithiasis and microlithiasis in children, Pediatr Nephrol 2009; 24: 2203-2209.
- Tekin A, Tekgul S, Atsu N, Bakkaloglu M, Kendi S, Oral potassium citrate treatment for idiopathic hypocitruria in children with calcium urolithiasis, J Urol 2002;168:2572-2574.
- Tekin A, Tekgul S, Atsu N, Sahin A, Ozen H, Bakkaloglu M, A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk factor, J Urol 2000;164:162-165.
- Baker PW, Coyle P, Bais R, Rofe AM, Influence of season, age, and sex on renal stone formation in South Australia, Med J Aust 1993;159:390392.
- Eisner BH, Sheth S, Herrick B, Pais VM Jr, Sawyer M, Miller N, et al, The effects of ambient temperature, humidity and season of year on urine composition in patients with nephrolithiasis, BJU Int 2012;110:10141017.
- Atan L, Andreoni C, Ortiz V, Silva EK, Pitta R, Atan F, et al, High kidney stone risk in men working in steel industry at hot temperatures, Urol 2005; 65: 858861
Öz
Aim: Children are an increasingly prevalent group of diseases in which environmental, genetic risk factors and metabolic disorders are associated in the formation of nephrolithiasis. The most prevalent metabolic abnormalities are hypocitraturia and hypercalciuria. The aim of our study is to assess the risk factors by determining the application dates, demographic, metabolic and clinical features of nephrolithiasis patients in the pediatric age group in the Mediterranean region.
Materials and Methods: We evaluated the clinical, radiological, laboratory findings and metabolic parameters of 129 children (74 boys and 55 girls) with nephrolithiasis between January 2015 and March 2018, retrospectively. Application dates of patients, symptoms, urinary infection, metabolic disturbances, radiological findings and treatment modalities were determined.
Results: A total of 129 patients, 55 (42.6%) were female and 74 (57.4%) were male, the mean age was 4.2 ± 4.7 years. 71.3% of the patients had unilateral and 24,8% of the patients had bilateral renal stones.
The most common clinical symptom was restlessness, renal colic and hematuria. When the metabolic evaluations were examined, 39 patients had hyperuricosuria, 29 had hypercalciuria, 14 had hypocitraturia and hyperoxaluria, and 3 had cystinuria. While urinary tract infection was detected in 23 patients, surgical treatment was required in addition to medical treatment in 15 patients. When the dates of arrival were investigated, it was found that most of the patients (67.4%) were admitted and diagnosed to the warm seasons (spring and summer).
Conclusion: We think that living in warm climates increase the risk of harboring kidney stones due to dehydration, which leads to a high excretion of urinary calcium and other minerals that promote the growth of kidney stones.
Anahtar Kelimeler
Kaynakça
- Clayton DB, Pope JC. The increasing pediatric stone disease problem. Ther Adv Urol 2011; 3: 3-12.
- Sas DJ, Hulsey TC, Shatat IF, Orak JK. Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 2010; 157, 132-7.
- Spivacow FR, Negri AL, del Valle EE, Calvino I, Fradinger E, Zanchetta JR, Metabolic risk factors in children with kidney stone disease, Pediatr Nephrol, 2008; 23: 1129-33.
- Baştuğ F, Gündüz Z, Tülpar S, Poyrazoğlu H, Düşünsel R, Urolithiasis in infants: evaluation of risk factors, World J Urol 2013; 31: 1117–22.
- Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, et al, Epidemiology of paediatric renal stone disease in the UK, Arch Dis Child 2003; 88: 962–5.
- Dursun I, Poyrazoglu HM, Dusunsel R, Gunduz Z, Gurgoze MK, Demirci D, et al. Pediatric urolithiasis: an 8-year experience of single centre, Int Urol Nephrol 2008; 40: 3–9
- Elder JS, Urinary lithiasis, In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Philadelphia: Saunders; 2008; 2267-72.
- Milliner DS, Urolithiasis, In: Avner ED, Harmon WE, Niaudet P, Pediatric nephrology, 5th ed, Philadelphia: Springer; 2009; p, 1405-1431.
- Alpay H, Gokce I, Ozen A, Bıyıklı N, Urinary stone disease in the first year of life: is it dangerous? Pediatr Surg Int 2013; 29: 311–316.
- Baştuğ F, Düşünsel R, Pediatric urolithiasis: causative factors, diagnosis and medical management, Nat Rev Urol 2012; 9: 138-146.
- Choi H, Synder HM, 3rd, Duckett JW, Urolithiasis in childhood: current management, J Pediatr Surg 1987; 22: 158–164,
- Miller LA,Stapleton FB, Urinary volume in children with urolithiasis, J Urol 1989;141: 918–920.
- Hoppe B, Leumann E, Milliner DS, Urolithiasis and nephrocalcinosis in childhood, In: Geary DF, Schaefer F (eds), Comprehensive Pediatric Nephrology, 1st edn, Mosby, Philadelphia, PA, 2008; 499-526.
- Poyrazoğlu HM, Düşünsel R, Yazici C, Durmaz H, Dursun I, Sahin H, et al, Urinary uric acid: creatinine ratios in healthy Turkish children, Pediatr Int 2009; 51: 526-529.
- Matos V, Van Melle G, Werner D, Bardy D, Guignard JP, Urinary oxalate and urate to creatinine ratios in a healthy pediatric population, Am J Kidney Dis 1999; 34:e1.
- Matos V, Van Melle G, Boulat O, Markert M, Bachmann C, Guignard JP, Urinary phosphate/creatinine, calcium/ creatinine, and magnesium/creatinine ratios in a healthy pediatric population, J Pediatr 1997;131:252-257.
- Habbig S, Beck BB, Hoppe B, Nephrocalcinosis and urolithiasis in children, Kidney Int 2011; 80: 1278-1291,
- Dinçel N, Özdemir K, Mir S, Demographic and Clinic Features of Children with Nephrolithiasis in Izmir, J Cont Med, 2012; 2: 77-81.
- Buttigieg J, Attard S, Carachi A, Galea R, Fava S, Nephrolithiasis, stone composition, meteorology, and seasons in Malta: Is there any connection? Urol Ann 2016; 8: 325-332,
- Sirohi M, Katz BF, Moreira DM, Dinlenc C, Monthly variations in urolithiasis presentations and their association with meteorologic factors in New York City, J Endourol 2014; 28: 599604.
- Baştuğ F, İnfantlarda Üriner Sistem Taş Hastalığı: Etyoloji ve Tedavi, Endoüroloji Bülteni 2013; 6: 143-151,
- Gillespie RS, Stapleton FB, Nephrolithiasis in Children, Pediatr Rev 2004; 25: 131–139.
- Afshin Safaei Asl, Shohreh Maleknejad, Pediatric Urolithiasis An Experience of a Single Center, Iranian Journal of Kidney Diseases 2011; 5: 309-313.
- Tiselius HG, Ackermann D, Alken P, Working Party on Lithiasis: European Association of Urology Guidelines on urolithiasis, Eur Urol 2001; 40: 362–71.
- Sternberg K, Greenfield SP, Williot P, Wan J, Pediatric stone disease: an evolving experience, J Urol 2005; 174: 1711–1714.
- Baysal YE, Koyun M, Akman S, Güven AG, Güntekin E, Çocuklarda ürolitiyazis: Antalya yöresinde 10 yıllık deneyim, Çoc Sağ ve Hast Der 2004; 47: 254-259.
- Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C, Guidelines on urolithiasis, Working Party on Lithiasis, European Association of Urology, 2012.
- Dursun İ, Ünsür EK, Çocuklarda üriner sistem taş hastalığına güncel yaklaşım, Çoc Cer Der 2016; 30: 146-155.
- Miyake O, Yoshimura K, Yoshioka T, Koide T, Okuyama A, High urinary excretion level of citrate and magnesium in children: potential etiology for the reduced incidence of pediatric urolithiasis, Urol Res 1998; 26: 209.
- Alpay H, Ozen A, Gokce I, Biyikli N, Clinical and metabolic features of urolithiasis and microlithiasis in children, Pediatr Nephrol 2009; 24: 2203-2209.
- Tekin A, Tekgul S, Atsu N, Bakkaloglu M, Kendi S, Oral potassium citrate treatment for idiopathic hypocitruria in children with calcium urolithiasis, J Urol 2002;168:2572-2574.
- Tekin A, Tekgul S, Atsu N, Sahin A, Ozen H, Bakkaloglu M, A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk factor, J Urol 2000;164:162-165.
- Baker PW, Coyle P, Bais R, Rofe AM, Influence of season, age, and sex on renal stone formation in South Australia, Med J Aust 1993;159:390392.
- Eisner BH, Sheth S, Herrick B, Pais VM Jr, Sawyer M, Miller N, et al, The effects of ambient temperature, humidity and season of year on urine composition in patients with nephrolithiasis, BJU Int 2012;110:10141017.
- Atan L, Andreoni C, Ortiz V, Silva EK, Pitta R, Atan F, et al, High kidney stone risk in men working in steel industry at hot temperatures, Urol 2005; 65: 858861
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Eylül 2021 |
| Gönderilme Tarihi | 6 Şubat 2020 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Sayı: 3 |
