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Urolithiasis in children, especially in adolescents, is increasingly being diagnosed. Calcium-oxalate urolithiasis is the most common cause of urolithiasis with the predominance of metabolic causes in early childhood, especially hypercalciuria and hyperoxaluria. In adolescence, the causes of stone formation are increasingly similar to those in adults with an increasing role of hypocitraturia and decreased urinary excretion of glycosaminoglycans. Cystinuria and urinary stones are less common causes of urinary tract stones in childhood. Particular attention is given to the role of urine pH and increased urine saturation. Proper diet and fluid intake can prevent the return of most urolithiasis in children. Citrate therapy should be limited to those children in whom control of urine saturation by diet cannot be achieved. Specific therapy is used in children with metabolic/genetic diseases and for some of whom gene therapy may soon be possible. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess demographic data, clinical presentation, metabolic features, and treatment in 76 children with urolithiasis presented from 2002 to 2011. Urolithiasis is responsible for 2.5/1,000 pediatric hospitalizations, with new cases diagnosed in 1.1/1,000 admissions. From the observed period, two-fold rise of incidence rate was observed. Compiling the data from other pediatric institutions in our country, we estimated present overall incidence rate in Croatia as 6.5/100,000 children under 18 years. There were 41 boys and 35 girls (ratio 1.17:1). The mean age at diagnosis was 9.7 (range 0.8-16) years and follow-up duration was 5.3 (range 1.8-10) years. Renal colic (75.0 %) and hematuria (57.89 %) were the main symptoms. In 65.78 % of children, stones were unilateral. Stones were located in kidney in 52.63 %, in the ureter in 26.32 %, and in bladder in 6.58 % cases. Stone analysis showed calcium oxalate in 75.0 % of the cases. Associated urinary tract abnormalities were found in 19.73 % children. Most common metabolic disturbances were hypercalciuria (47.37 %) and idiopathic or mild hyperoxaluria (18.42 %). Urine saturation (EQUIL2) was elevated in 61.84 % cases. Spontaneous stone evacuation occurred in 51.21 % children. Extracorporeal shock wave lithotripsy, surgical evacuation, and endoscopic removal of calculi were performed in 21.0, 6.58, and 5.26 % of cases, respectively. Follow-up conservative therapy, consisting of fluid/diet recommendations and additional potassium citrate and/or chlorothiazide in children with increased risk, was sufficient for stone recurrence prevention in 92.1 % of children. In conclusion, the study gave insight in epidemiology and metabolic disturbances of urinary stone disease in Croatian children. [ABSTRACT FROM AUTHOR]

During ceftriaxone treatment of subdural empyema caused by Streptococcus intermedius urinary and biliary stones were noticed. Increased levels of urinary calcium excretion were detected during ongoing treatment in comparison with 2 months check-up. There were no significant changes in the promoter/inhibitor urolithiasis parameters, oxalate, citrate, urate, cistine, glycosaminoglycans or their ratios. Urine saturation was calculated using EQUIL 2 computer programme (calcium oxalate, brushite) and it was normal. Probable trigger for the ceftriaxone/calcium hydroxy carbonate phosphate mixture of stones was a critical boost of solubility products caused by ceftriaxone treatment and phospnate urine content with a subsequent large-scale spontaneous precipitation of crystals. [ABSTRACT FROM AUTHOR]

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