1. AETIOPATHOGENESIS,DIAGNOSIS
AND MANAGEMENT OF
UROLITHIASIS IN CHILDREN
BY
IMOUDU I A
MODERATOR PROF AIKHIONBARE H A

2. OUTLINE
• INTRODUCTION
• EPIDEMIOLOGY
• AETIOPATHOGENESIS
• CLINICAL PRESENTATION
• DIAGNOSIS
• MANAGEMENT
• PROGNOSIS
• CONCLUSION

3. INTRODUCTION
• THE EXISTENCE OF CALCULI IN THE URINARY
TRACT HAS BEEN RECORDED SINCE THE
BEGINNING OF CIVILIZATION
• LITHOTOMY FOR THE REMOVAL OF STONES IS
ONE OF THE EARLIEST KNOWN SURGICAL
PROCEDURES
• A PELVIC STONE DATING BACK TO 4800BCE WAS
DISCOVERED IN AN EGYPTIAN MUMMY IN 1901

4. INTRODUCTION
• MEDICAL TEXTS FROM ANCIENT MESOPOTAMIA,
INDIA,CHINA,PERSIA,GREECE & ROME ALL
MENTIONED CALCULOUS DISEASE
• PART OF THE HIPPOCRATIC OATH CONTAINS
AN ADMONITION ABOUT THE DANGERS OF
OPERATING ON THE BLADDER FOR STONES

5. EPIDEMIOLOGY
• GLOBAL DISEASE
• COMMONER IN EASTERN EUROPE,SOUTHEAST
ASIA,INDIA & THE MIDDLE EAST
• IN RSA IT IS COMMONER IN WHITES
• IN USA IT IS COMMONER IN WHITES THAN
BLACKS,ASIAN & LATIN AMERICANS

6. EPIDEMIOLOGY
• AFFECTS ALL AGE GROUPS
• RARE IN CHILDREN - 7% OF ALL CASES
• COMMONER IN BOYS 3:2
• ADULTS,M/F 4:1

7. AETIOPATHOGENESIS
• THERE IS CONTINUOUS INTERACTION B/W
FACTORS THAT PROMOTE & THOSE THAT
INHIBIT CRYSTALLIZATION IN THE FLUIDS OF
THE URINARY TRACT
• STONES FORM AROUND A NUCLEUS OR
NIDUS

8. AETIOPATHOGENESIS
CRYSTALS EVOLVE IN THE PRESENCE OF SUBSTANCES
LIKE
• Ca-OXALATE
• CaCO3
• Mg
• NH4
• PO4
• URIC ACID

9. AETIOPATHOGENESIS
STONES IN URINARY TRACT COMMONLY COMPOSE
OF
• Ca-OXALATE/CaPO4 75-80%
• STRUVITE 15%
• URIC ACID 7%
• CYSTINE 1%
• OTHERS <1%

10. AETIOPATHOGENESIS
RISK FACTORS
• DEHYDRATION
• INFECTION
• CHANGES IN URINE pH
• OBSTRUCTION OF URINE FLOW
• IMMOBILIZATION
• DIET
• GOUT
• FAT MALABSORPTION

11. AETIOPATHOGENESIS
SOME ASSOCIATED METABOLIC CONDITIONS
• HYPERVITAMINOSIS D
• HYPEROXALURIA
• RENAL TUBULAR ACIDOSIS(TYPE 1)
• HYPERURICOSURIA
• HYPOCITRURIA
• CYSTINURIA
• SARCOIDOSIS

12. Kidney stone
Classification and external resources

15. CLINICAL PRESENTATION
• COLICKY ABDOMINAL PAIN
• HAEMATURIA
• DYSURIA
• FEVER
• DRIBBLING OF URINE
• WEIGHT LOSS
• PYURIA
• OLIGURIA
• ANOREXIA
• VOMITING

16. DIAGNOSIS
• PLAIN ABDOMINAL X-RAY
• CT-SCAN
• ABDOMINAL ULTRASOUND SCAN
• URINALYSIS
• URINE M/C/S
• U/E+CREATININE,Ca

17. DIAGNOSIS
• FBC+DIFF
• 24HR URINE COLLECTION FOR Mg,Na,Ca,URIC
ACID,CITRATE,OXALATE & PO4
• CATCHING OF PASSED STONES FOR ANALYSIS
• IVU

18. MANAGEMENT
MEDICAL
• TREAT UNDERLYING METABOLIC DISEASE
• ADEQUATE HYDRATION
• DIETARY MODIFICATION
• ALPHA ADRENERGIC BLKERS;
TAMSULOSIN,TERAZOSIN,DOXAZOSIN
• Ca CHANNEL BLKERS
• ALKALIZATION/ACIDIFICATION OF URINE
• ANALGESIA

19. MANAGEMENT
SURGICAL
INDICATIONS FOR SURGERY;
• PERSISTENT & SEVERE PAIN
• RENAL INFECTION
• RENAL FAILURE
• FAILURE OF MEDICAL MANAGEMENT

20. MANAGEMENT
SURGICAL PROCEDURES
• LITHOTRIPSY- ESWL
• ENDOSCOPIC FRAGMENTATION
• PERCUTANEOUS NEPHROLITHOTOMY
• LITHOTOMY

21. PROGNOSIS
• USUALLY NOT FATAL
• 90% OF STONES 4mm OR LESS IN SIZE PASS
SPONTANEOUSLY
• DEATH MAY RESULT FROM COMPLICATIONS
&/OR UNDERLYING CAUSE

22. • Emperor of france 1804- 1815

23. • Nepoleon 111 ruler of france 1850-1870

24. • Sir isaac newton 1642- 1727

25. • Lyndon B Johnson president from 1963- 1969

26. CONCLUSION
• THOUGH A VERY RARE CONDITION AMONG
CHILDREN IN THIS ENVIRONMENT,THOSE
WHO DEVELOP VERY PAINFUL STONES MAY
EXPERIENCE SIGNIFICANT MORBIDITY
• THERE MAY BE NEED FOR A HIGH INDEX OF
SUSPICION,ESPECIALLY IN PRE-SCHOOL AGE
CHILDREN WITH RECURRENT ABDOMINAL
PAIN

27. THANK
YOU

28. REFERENCES
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• http//en. Wikipedia.org
• http//www.eMedicine.com
• Hulton SA.Evaluation of Urinary tract Calculi in
children.Arch.Dis.child.2001;84:320-23

29. REFERENCES
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30. REFERENCES
• Abubakar AM,Mungadi IA,Chinda JY,Ntia IO,Jalo
I,Obiano SK.Paediatric Urolithiasis in Northern
Nigeria.African Journal of Paediatric
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• Angwafo FF et al.Paediatric Urolithiasis in
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