title: Evaluation of children with urolithiasis.
abstract: OBJECTIVE
  To describe an evaluation protocol for pediatric stone formers for risk assessment and management strategies.
  
  
  METHODS
  Between 2002-2006, 2618 children of age three months to 15 years were evaluated for stone disease. Evaluation included demographics, history, anthropometry, diet, ultrasound, X-ray KUB, IVU, blood and 24h urine chemistry and cultures. Stones were analyzed by IR spectroscopy.
  
  
  RESULTS
  The median age was seven years with a M:F ratio of 2.2:1. Of the 2618 patients, 2216 presented with normal renal function and 402 with renal failure. Main symptoms were abdominal pain (33%), flank pain (38%) and fever (38%). Renal failure patients also had shortness of breath (38%) and oligo-anuria (26%). Children were malnourished with height and weight deficits in 65% and 76% respectively. Diet was low in protein (74%), calcium (55%) and fluids in (55%), high in oxalate (55%), sodium (39%), purines (42%) and refined sugar (41%). Overall urine cultures were positive in 1208 (46%) with E. coli (38%) and Klebsiella (8%). Stone distribution was renal in 64%, ureter in 8%, bladder in 18%, bilateral in 40% and multiple sites in 18%. Median stone size was >1.5-2.0 cm. The frequency of compounds in stones was ammonium urate (58%), calcium oxalate (63%), uric acid (6%), calcium phosphate (12%) and struvite (8%). Metabolic abnormalities included hypovolumia (31%), hypocitraturia (87%), hyperoxaluria (43%) and hyperuricosuria (26%). Dietary and medical treatment corrected risk factors in two-thirds of patients with a recurrence rate of about 1.15%.
  
  
  CONCLUSIONS
  An evaluation based on history, imaging, diet, metabolic analysis and stone type can help to tailor management strategies.
authors.affiliation: Department of Urology, Sindh Institution of Urology and Transplantation, Civil Hospital, Karachi - 74200, Pakistan.
authors.forename: Syed A H
authors.initials: SA
authors.lastname: Rizvi
authors.forename: Sajid
authors.initials: S
authors.lastname: Sultan
authors.forename: Mirza N
authors.initials: MN
authors.lastname: Zafar
authors.forename: Bashir
authors.initials: B
authors.lastname: Ahmed
authors.forename: Syed M
authors.initials: SM
authors.lastname: Faiq
authors.forename: Kehkashan Z
authors.initials: KZ
authors.lastname: Hossain
authors.forename: Syed A A
authors.initials: SA
authors.lastname: Naqvi