title: Kidney Stone Recurrence among Children and Adolescents.
abstract: Kidney stone disease has become increasingly common during childhood and adolescence. However, the rate of symptomatic kidney stone recurrence for pediatric patients is uncertain. We sought to determine the recurrence rate of symptomatic kidney stones in a cohort of children with incident symptomatic nephrolithiasis.
  
  
  
  We performed a retrospective cohort study of patients 3 to 18 years old without anatomical abnormalities or genetic causes of nephrolithiasis who presented with a first symptomatic kidney stone between 2008 and 2014. We determined recurrence rates of symptomatic nephrolithiasis, defined as a new kidney stone on ultrasound and/or computerized tomogram associated with pain and/or vomiting. We also estimated associations between completing 24-hour urinalysis and symptomatic kidney stone recurrence using Kaplan-Meier curves and multivariable Cox regression models.
  
  
  
  A total of 285 children with a median age of 14.8 years (IQR 11.3-16.6) at nephrolithiasis diagnosis were followed for 492 person-years. A total of 86 symptomatic recurrent stones developed in 68 patients (24%) during the followup period. The probability of symptomatic stone recurrence was 50% at 3 years after the index kidney stone. Median time to stone recurrence was 3 years at the first recurrence and 5 years at the second. Adjusting for confounders including adherence to followup, completing a 24-hour urinalysis after a kidney stone episode was associated with a 60% decreased risk of recurrence (hazard ratio 0.40, 95% CI 0.18-0.91).
  
  
  
  The risk of kidney stone recurrence is high during childhood, with approximately 50% of children presenting with symptomatic recurrence within 3 years of the first stone. The role and usefulness of analyzing 24-hour urine chemistries in decreasing kidney stone recurrence should be explored in future prospective studies.
authors: Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: tasiang@chop.edu.
authors: Gregory E
authors: GE
authors: Tasian
authors: Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Abdo E
authors: AE
authors: Kabarriti
authors: Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Angela
authors: A
authors: Kalmus
authors: Department of Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Susan L
authors: SL
authors: Furth
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007669:Kidney Calculi / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D015143:Philadelphia; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D016482:Urinalysis / Q000379:methods
keywords: child; nephrolithiasis; recurrence; urinalysis