Evaluation of pediatric nephrolithiasis in children
Nephrolithiasis in the pediatric population is an important cause of morbidity worldwide. Presenting signs and symptoms are often considerably different from those in adults. Vague abdominal pain, hematuria, and urinary tract infection are more common in children than the classic colicky flank pain. Imaging of suspected cases should be undertaken with careful consideration of diagnostic accuracy and the potentially harmful effects of ionizing radiation. Because children with nephrolithiasis have a high chance of recurrent stone formation, a thorough risk assessment and metabolic evaluation should be performed.
Evaluation of pediatric nephrolithiasis:
- Stone analysis
- Urinalysis
- Urine culture
- Spot urine: calcium–to-creatinine ratio
- Serum chemistries: electrolytes, uric acid, creatinine, calcium, phosphorus, bicarbonate, and magnesium.
- 24-hour urine
- pH
- Urine volume
- Calcium, Oxalate, Uric acid, Cystine, Citrate, Magnesium, sodium, Phosphorus and Potassium adjusted for urinary creatinine (mg/mg creatinine)
- Super saturation indices of calcium oxalate, calcium monohydrogen phosphate and uric acid
The evaluation of nephrolithiasis in children differs from that of adults. The non-classical and often vague presentation requires a high level of clinical suspicion. Imaging must be undertaken with care to identify stones while avoiding excess radiation exposure. Because of the prevalence of metabolic risk factors and the significant risk of recurrence in this population, all children require a complete evaluation with metabolic workup.
