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Introduction: Renal stone disease diagnosed in the first year of life is relatively uncommon. While risk factors such as low birth weight, furosemide exposure, and metabolic disorders are well established, there exists little information regarding resolution rates and need for surgical intervention. Our study objective was to evaluate urolithiasis and renal calcification resolution rates, time to resolution, and need for surgical intervention in children diagnosed in their first year of life., Material and Methods: REB approved retrospective chart review of children younger than 12 months of age (corrected for prematurity) diagnosed with nephrolithiasis and/or nephrocalcinosis in a tertiary pediatric hospital between April 2000 and August 2015 with a minimum 1-year follow-up period. Exact logistic regression was performed to assess the relationship between size of the largest stone (on either side) and the need for surgical intervention. Kaplan-Meier curves were constructed to examine time to stone resolution among those not requiring surgical intervention., Results: 62 patients (61% male) were diagnosed with stones or nephrocalcinosis by ultrasound at a median age of 2.9 months. Of these, 37% had been admitted to the NICU because of prematurity, low birth weight or comorbidities. A total of 45 patients were found to have stones (Table); 35 of these had a stone at initial ultrasound and 10 initially diagnosed as nephrocalcinosis were later confirmed to have a stone. 67% of all stones were asymptomatic on presentation. Metabolic anomalies were present in 56% (35/62), and 16% (10/62) required medical treatment. Seven patients ultimately required surgical intervention. Stone size was found to predict the eventual need for surgical intervention (OR 3.52, 95% CI 1.47-12.78) for each 0.1 mm increase in diameter). Among patients not requiring surgical intervention (n = 38), the estimated median time to spontaneous resolution of urolithiasis was 1.1 years (95% CI 0.89-1.53, range 2 months-6 years) and 1.2 years for nephrocalcinosis (95% CI 0.59-2.13)., Conclusions: Spontaneous resolution was a common outcome for newborns and infants diagnosed with urolithiasis in the first year of life, but high variability in time-to-resolution was observed. Only a small proportion who had confirmed stones on ultrasound required surgical intervention (15%), and large stone size was a predictive factor for surgery., (Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Asymptomatic, or incidental, pediatric kidney stones detected on abdominal imaging pose a clinical challenge as their significance and expected outcome are not well described. Our primary objective was to estimate the incidence of nephrolithiasis in pediatric patients undergoing abdominal ultrasound (US) or computerized tomography (CT), for all indications, in a pediatric tertiary care hospital. Our secondary objective was to determine the clinical outcome of these radiographically detected stones. All abdominal US or CT radiology reports for patients younger than 18 years between January 1, 2011, and December 31, 2016, were retrieved. Reports were automatically flagged using textual analysis if they contained one of the 32 keywords potentially indicating nephrolithiasis. Flagged reports, as well as 10% of unflagged reports, were reviewed to confirm the radiologist impression of presence or absence of stones. Patient and stone-related clinical data were extracted. Two thousand four hundred forty-nine (5%) of 53 235 imaging reports cited at least one of the keywords. Manual review of flagged reports identified 498 studies having a radiologist impression of stones (244 unique patients). Stone incidence in children undergoing abdominal imaging more than doubled between 2011 and 2016. Medical record review found that 140 patients (57%) were symptomatic, while the other 104 patients (43%) were asymptomatic. Spontaneous resolution was greater (57% vs 34%) in asymptomatic patients compared to symptomatic patients. Asymptomatic patients were younger with a median age of 0.6 compared to 12.3 years. Asymptomatic and symptomatic stones were followed up for similar lengths of time (2.3 vs 2.0 years, p > 0.05) and had a similar number of follow-up USs (3.9 vs 4.6 studies, p > 0.05). The incidence of radiologically identified stones in children undergoing abdominal imaging at our center increased over time. Asymptomatic stones follow a benign course with minimal need for intervention; however, they were detected almost as frequently as symptomatic stones. Asymptomatic stones may represent increased healthcare resource utilization due to similar follow-up compared to symptomatic stones. Further research regarding the optimal imaging intervals and long-term follow-up for asymptomatic stones is warranted. Summary Fig. Image 1 [ABSTRACT FROM AUTHOR]