title: Metabolic risk factors in pediatric stone formers: a report from an emerging economy.
abstract: The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15 years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15 years. Patients were evaluated for demographics, blood and 24 h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.
authors.affiliation: Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. kiranimran10@gmail.com.
authors.forename: Kiran
authors.identifier: http://orcid.org/0000-0003-1422-0058
authors.initials: K
authors.lastname: Imran
authors.affiliation: Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Mirza Naqi
authors.initials: MN
authors.lastname: Zafar
authors.affiliation: Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Uzma
authors.initials: U
authors.lastname: Ozair
authors.affiliation: Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Sadia
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Syed Adibul Hasan
authors.initials: SAH
authors.lastname: Rizvi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000641:Ammonia / Q000652:urine; D002118:Calcium / Q000097:blood / Q000652:urine; D002648:Child; D002675:Child, Preschool; D002951:Citrates / Q000097:blood / Q000652:urine; D003967:Diarrhea / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010070:Oxalates / Q000652:urine; D010154:Pakistan; D010710:Phosphates / Q000097:blood / Q000652:urine; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood / Q000652:urine; D014552:Urinary Tract Infections / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism / Q000652:urine; D052878:Urolithiasis / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism / Q000652:urine
chemical_list: D002951:Citrates; D010070:Oxalates; D010710:Phosphates; D014527:Uric Acid; D000641:Ammonia; D002118:Calcium
keywords: Metabolic; Pediatric; Risk factors; Urolithiasis