Zhong Qingtao,Zhang Deying,Wang Xuan,et al.Analysis of risk factors and causes of early recurrence of children with upper urinary tract calculi[J].Journal of Clinical Pediatric Surgery,,22():635-641.[doi:10.3760/cma.j.cn101785-202211008-007]
Analysis of risk factors and causes of early recurrence of children with upper urinary tract calculi
- Keywords:
- Urolithiasis; Risk Factors; Recurrence; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the risk factors of upper urinary tract calculi (UUTC) and identify the causes of early recurrence in children.Methods For this case-control study, clinical data were retrospectively reviewed for 129 UUTC children at Children’s Hospital of Chongqing Medical University from January 2017 to April 2021.They were assigned into two groups of UUTC (case, n=129) and non-UUTC (control, n=130).Social demographics, family history of calculi, dietary intake, water intake and urination were compared.Univariate and multivariate Logistic regression analyses were performed for identifying the independent risk factors and examining the effect of each factor on early recurrence of UUTC.Results There were 81 boys and 48 girls with an age range of (7.58±4.02) years.Logistic regression analysis indicated that high sodium diet(OR=4.199, 95%CI:1.418~12.440), high calcium intake(OR=5.043, 95%CI:1.720~14.788), low water intake(OR=2.691, 95%CI:1.125~6.435), low urinary output(OR=2.462, 95%CI:1.108~5.470), a family history of UUTC(OR=2.041, 95%CI:1.137~3.664) and congenital abnormalities of upper urinary tract(OR=7.133, 95%CI:1.420~35.817) were independent risk factors for UUTC in children.The early recurrence rate of calculi was 8.5%(11/129) and the causes for early recurrence were primary hyperoxaluria (3/6), cystinuria (2/6) and low urinary output (1/6).Conclusion High sodium diet, high calcium intake, low water intake, low urinary output, a family history of UUTC and congenital malformation of upper urinary tract are correlated closely with UUTC in children.Inherited metabolic diseases and low urinary output are the major causes of early recurrence.
References:
[1] Tasian GE, Ross ME, Song LH, et al.Annual incidence of nephrolithiasis among children and adults in South Carolina from 1997 to 2012[J].Clin J Am Soc Nephrol, 2016, 11(3):488-496.DOI:10.2215/CJN.07610715.
[2] Farris N, Raina R, Tibrewal A, et al.Acute kidney injury associated with urinary stone disease in children and young adults presenting to a pediatric emergency department[J].Front Pediatr, 2020, 8:591520.DOI:10.3389/fped.2020.591520.
[3] 曾国华, 麦赞林, 夏术阶, 等.中国成年人群尿石症患病率横断面调查[J].中华泌尿外科杂志, 2015, 36(7):528-532.DOI:10.3760/cma.j.issn.1000-6702.2015.07.014. Zeng GH, Mai ZL, Xia SJ, et al.A cross-sectional survey of urolithiasis prevalence in China[J].Chin J Urol, 2015, 36(7):528-532.DOI:10.3760/cma.j.issn.1000-6702.2015.07.014.
[4] 李辉, 季成叶, 宗心南, 等.中国0~18岁儿童、青少年身高、体重的标准化生长曲线[J].中华儿科杂志, 2009, 47(7):487-492.DOI:10.3760/cma.j.issn.0578-1310.2009.07.003. Li H, Ji CY, Zong XN, et al.Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years[J].Chin J Pediatr, 2009, 47(7):487-492.DOI:10.3760/cma.j.issn.0578-1310.2009.07.003.
[5] 中华预防医学会儿童保健分会.中国儿童钙营养专家共识(2019年版)[J].中国妇幼健康研究, 2019, 30(3):262-269.DOI:10.3969/j.issn.1673-5293.2019.03.001. Children’s Healthcare Branch of Chinese Preventive Healthcare Association:Consensus of Chinese Pediatric Calcium Nutrition Experts (2019 Edition)[J].Chin J Woman Child Health Res, 2019, 30(3):262-269.DOI:10.3969/j.issn.1673-5293.2019.03.001.
[6] 杨月欣.国内外水适宜摄入量的制定[C]//达能营养中心第二十二届学术会议——饮水、水合状态与健康会议论文集.宁波:中国疾病预防控制中心达能营养中心, 2019:8-12.DOI:10.26914/c.cnkihy.2019.036943. Yang YX.Formulation of appropriate water intake at home and abroad[C]//Proceedings of XXII Academic Congress of Danone Nutrition Center on Drinking Water, Hydration Status and Health.Ningbo:Danone Nutrition Center of Chinese Center for Disease Control and Prevention, 2019:8-12.DOI:10.26914/c.cnkihy.2019.036943.
[7] Siener R.Nutrition and kidney stone disease[J].Nutrients, 2021, 13(6):1917.DOI:10.3390/nu13061917.
[8] Cambareri GM, Kovacevic L, Bayne AP, et al.National multi-institutional cooperative on urolithiasis in children:age is a significant predictor of urine abnormalities[J].J Pediatr Urol, 2015, 11(4):218-223.DOI:10.1016/j.jpurol.2015.04.021.
[9] Abufaraj M, Xu TL, Cao C, et al.Prevalence and trends in kidney stone among adults in the USA:analyses of National health and nutrition examination survey 2007-2018 data[J].Eur Urol Focus, 2021, 7(6):1468-1475.DOI:10.1016/j.euf.2020.08.011.
[10] Fink HA, Wilt TJ, Eidman KE, et al.Medical management to prevent recurrent nephrolithiasis in adults:a systematic review for an American College of Physicians Clinical Guideline[J].Ann Intern Med, 2013, 158(7):535-543.DOI:10.7326/0003-4819-158-7-201304020-00005.
[11] Taylor EN, Curhan GC.Dietary calcium from dairy and nondairy sources, and risk of symptomatic kidney stones[J].J Urol, 2013, 190(4):1255-1259.DOI:10.1016/j.juro.2013.03.074.
[12] Y?lmaz A?, Vnal N.Do dietary factors play a role in infantile urolithiasis?[J].Pediatr Nephrol, 2022, 37(12):3157-3163.DOI:10.1007/s00467-022-05501-9.
[13] Lin BB, Lin ME, Huang RH, et al.Dietary and lifestyle factors for primary prevention of nephrolithiasis:a systematic review and meta-analysis[J].BMC Nephrol, 2020, 21(1):267.DOI:10.1186/s12882-020-01925-3.
[14] ?altik Yilmaz A, Vnal N, ?elebi Tayfur A, et al.How important urolithiasis is under 2 years of age?[J].Urolithiasis, 2022, 50(2):159-165.DOI:10.1007/s00240-021-01295-x.
[15] Bao YG, Tu X, Wei Q.Water for preventing urinary stones[J].Cochrane Database Syst Rev, 2020, 2(2):CD004292.DOI 10.1002/14651858.CD004292.pub4.
[16] Sulaiman SK, Enakshee J, Traxer O, et al.Which type of water is recommended for patients with stone disease (hard or soft water, tap or bottled water):evidence from a systematic review over the last 3 decades[J].Curr Urol Rep, 2020, 21(1):6.DOI:10.1007/s11934-020-0968-3.
[17] Zeng GH, Mai ZL, Xia SJ, et al.Prevalence of kidney stones in China:an ultrasonography based cross-sectional study[J].BJU Int, 2017, 120(1):109-116.DOI:10.1111/bju.13828.
[18] 丛小明, 孙西钊.儿童泌尿系统结石的代谢评估[J].临床小儿外科杂志, 2020, 19(8):661-665.DOI:10.3969/j.issn.1671-6353.2020.08.001. Cong XM, Sun XZ.Metabolic evaluations of pediatric nephrolithiasis[J].J Clin Ped Sur, 2020, 19(8):661-665.DOI:10.3969/j.issn.1671-6353.2020.08.001.
[19] Zhao YN, Fang XL, He L, et al.A comparison of the clinical characteristics of pediatric urolithiasis patients with positive and negative molecular diagnoses[J].World J Urol, 2022, 40(5):1211-1216.DOI:10.1007/s00345-022-03934-3.
[20] Patel SR, Ingram C, Scovell JM, et al.The microbiome and urolithiasis:current advancements and future challenges[J].Curr Urol Rep, 2022, 23(3):47-56.DOI:10.1007/s11934-022-01088-8.
Memo
收稿日期:2022-11-05。
基金项目:重庆市科卫联合项目（2019GDRC007）；重庆市渝中区科学技术局基础研究与前沿探索项目（20200126）；重庆医科大学未来医学青年创新团队支持计划（W0056）；重庆市科卫联合中医药技术创新与应用发展项目（2020ZY023877）
通讯作者:张德迎,Email:dzdy199@126.com