CLINICAL-EPIDEMIOLOGICAL PROFILE OF 106 PEDIATRIC PACIENTS WITH UROLITHIASIS IN RIO DE JANEIRO, BRAZIL

ABSTRACT Objective: To describe the frequency, clinical profile and treatment of patients with urolithiasis in the Pediatric Nephrology Department of a public state hospital in Rio de Janeiro, Brazil. Methods: Retrospective study. Data from pediatric patients (age: 1 month - 18 years) with urolithiasis admitted between January/2012 and December/2014 were reviewed from hospital charts. The studied variables were: demographic and anthropometric data, clinical status, family history of urolithiasis, urinary tract infection and use of lithogenic drugs, diagnostic procedures, associated abnormalities, metabolic disorders, treatment and recurrence. Results: The frequency of urolithiasis was 13.6%. Main characteristics of the patients: male gender, white race, eutrophy, aged between 5 and 10 years, family history of urolithiasis, previous urinary infection and spontaneous stone passage. Abdominal and flank pain and macroscopic hematuria were the most common complaints. The most frequent metabolic disorders were hypercalciuria, hyperuricosuria and hypocitraturia. Hypocitraturia was associated with previous urinary infection (p=0.004). Abdomen/urinary tract ultrasonography was the most commonly used diagnostic test. Hydronephrosis occurred in 54.4% of the cases, 81.1% of the stones were in the kidneys, and bilateral stones were associated to a family history of urolithiasis (p=0.030). Recurrence rate was 29.3% (most patients had a metabolic disorder). In 12.3%, the patients underwent lithotripsy, 24.5% were surgically treated (mainly pyelolithotomy), and only 7.6% had their stones analyzed (calcium oxalate was the main finding in the examined stones). Conclusions: The frequency of urolithiasis in these pediatric patients was similar to that reported by the literature. A metabolic evaluation is required and the composition of stones should be better evaluated.

摘要
目的：描述巴西里约热内卢某公立州立医院儿童肾病科收治的尿路结石症（urolithiasis）患者的发病频率、临床特征及治疗方案。
方法：本研究为回顾性研究。调取2012年1月至2014年12月期间收治的年龄为1月龄至18岁的儿科尿路结石症患者的住院病历进行回顾分析。本次研究的观察变量包括：人口学与人体测量学资料、临床状态、尿路结石症家族史、尿路感染（urinary tract infection）及致石药物（lithogenic drugs）使用情况、诊断操作、合并异常、代谢紊乱、治疗方案及复发情况。
结果：本队列中尿路结石症的发病频率为13.6%。患者的主要临床特征为：男性性别、白人种族、营养状态正常，年龄介于5至10岁，存在尿路结石症家族史、既往尿路感染史及自发排石史。最常见的临床表现为腹痛与胁腹痛、肉眼血尿。最常见的代谢紊乱类型为高钙尿症、高尿酸尿症及低枸橼酸尿症，其中低枸橼酸尿症与既往尿路感染史存在显著相关性（p=0.004）。腹部/尿路超声检查（ultrasonography）为最常使用的诊断手段。肾积水（hydronephrosis）发生率为54.4%，81.1%的结石位于肾脏，双侧结石与尿路结石症家族史存在显著相关性（p=0.030）。总体复发率为29.3%，多数复发患者合并代谢紊乱。12.3%的患者接受了碎石治疗，24.5%的患者接受了手术治疗（以肾盂切开取石术（pyelolithotomy）为主），仅7.6%的患者接受了结石成分分析，其中检出的主要结石成分为草酸钙（calcium oxalate）。
结论：该儿科队列的尿路结石症发病频率与文献报道结果相近。临床实践中需完善代谢评估，并加强结石成分分析工作。