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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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NEPHROLITHIASIS IN A PORTUGUESE PAEDIATRIC POPULATION

Joana Verdelho Andrade1, Sofia Bota2, Telma Francisco2, Raquel Santos2, Ana Paula Serrão2, Gisela Neto2, Margarida Abranches2

1- Pediatrics Department, Centro Hospitalar Tondela-viseu, Portugal
2- Pediatric Nephrology Department, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal

- ESPN 50th Annual Meeting, Poster – ESPN 50th Annual Meeting, 6-9/9/2017, Glasgow, Scotland (poster)
- Publicação sob a forma de resumo: Pediatr Nephrol (2017) 32: 1779-1780. https://doi.org/10.1007/s00467-017-3753-x

Resumo:
Introduction/Aim: To determine the epidemiology and outcome of a paediatric population presented to a nephrology unit in an urban tertiary centre.
Material and methods: The records of consecutive children (0–18 years) with nephrolithiasis were reviewed (January 2008–December 2016). Clinical features, aetiology, recurrence risk, treatment and outcome were retrospectively evaluated.
Results: We identified 104 cases: nephrolithiasis (n = 69), nephrocalcinosis (n = 24), and both disorders (n = 11). New nephrolithiasis cases (n = 80) increased through the study period from 2.3% to 11.8%. Age at presentation (median 8.6 years) was below 2 years in 21% and 46% were older than 10 years; mean follow-up was 29 months (2–108). Boys predominate (59%). The most common presenting symptom was flank or abdominal pain (44%). The upper urinary tract was most commonly affected (89%). A metabolic abnormality was identified in 51% of cases: hypocitraturia (57%), hypercalcuria (43%), hyperoxaluria (19%), hyperuricosuria (12%), and cystinuria (2%) without age predominance (p = 0,2). Urinary tract infection (UTI) (24%) was the next most significant aetiology. Children below 2 years of age were more likely to have UTI as a cause than the other age groups (p < 0,01). Cases with UTI were more likely to need surgical treatment (p < 0,01). Sixty-three percent of patients were stone free and 24% had recurrence. DMSA scanning was abnormal in 9/20 cases (45%). In a logistic-regression analysis adjusted for age, sex, weight, dietary errors, type of calculi and recurrence of symptoms, a known family history of nephrolithiasis was associated with an increased risk of a metabolic cause for the calculi (odds ratio = 6,86; 95% confidence interval [CI], 1663 to 28,302; p < 0.01).
Conclusions: Nephrolithiasis increased throughout the study period. UTI predominate at younger ages. Metabolic abnormalities usually have an arousing effect in nephrolithiasis and recurrence rates, validating the need for a complete screening in children.

Palavras Chave: hypercalcuria, hyperoxaluria, hyperuricosuria, hypocitraturia, nephrolithiasis