دوشنبه 1 آبان 1396
به پورتال جامع کنگره ها - سمینارها و همایشهای دانشگاه علوم پزشکی تبریز خوش آمدید
   October 23, 2017
   
   
     
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عنوان Approach to Urinary Stone in Pediatric Emergency Room (A Review)
نویسندگان Dr. Afshin Ghalehgolab Behbahan M.D. Associate Professor of Pediatric Nephrology,
چکیده Introduction Urinary Stone in children is a common cause of morbidity worldwide. Urolithiasis may induce pain, infection, and renal tissue damage that can result in renal failure if severe. Contrary to adult cases, gender distribution is almost equal, or even shows a female preponderance in children. Nephrolithiasis is seen in all pediatric age groups; including infants who represent about 20% of cases in children. Discussion Clinical Manifestation: The classic unilateral colicky flank pain -which is usually seen in adults- occurs in only about 7% of pediatric cases. Common manifestation of renal stone in children include: vague abdominal pain (65%), gross or microscopic hematuria (40%) and urinary tract infection (UTI in 25%). In children under 5 years of age, UTI and incidental finding of nephrolithiasis is more common, consisting up to 62% of cases in this age group. In all ages, it is too important to diagnose the coincidence of an obstructing stone and UTI as this can rapidly lead to pyonephrosis and urosepsis. Laboratory Studies: Urinalysis (U/A) is necessary in all children suspected of suffering from urolithiasis. Microscopic hematuria is the most common finding in U/A (60-95%). Pyuria can be found in 20% of cases without UTI; but if there is an associated UTI, leukocyte esterase and nitrites may be detected too. CBC and urine culture should be done if the child has fever or dysuria. Imaging: The gold standard for detection of urinary stones in both children and adults is the non-contrast spiral computed tomography (CT) scan; however, its substantial hazards of radiation, cost and availability must be considered. Therefore ultrasonography (US) is the modality of choice for initial imaging in children who need to be evaluated for nephrolithiasis; it has a high sensitivity for detection of kidney stones (up to 90%), although lower for ureteral stones (67%). Despite such limitation, US is the first test in pediatric emergency room for those who are suspected to have urinary stones. Intravenous pyelography (IVP) can show radiolucent stones undetectable by conventional abdominal X-ray. Risk Evaluation: A detailed history including family history of stone disease and renal dysfunction should be taken. Besides, a careful dietary history is necessary, considering child’s protein, sodium, calcium, and oxalate intake. Child’s past-medical history is also important to review previously recognized anatomical abnormalities and known metabolic disorders. Metabolic Evaluation: Pediatric stone-formers tend to have some degrees of dehydration caused by insufficient fluid intake and hyperperspiration due to over-heating and/or over-clothing; this may play the single most axial role in stone formation and its recurrence. The main metabolic derangements that must be investigated in children with nephrolithiasis include: Hypercalciuria seen (in 50%), Hyperoxaluria (in up to 20%), Hyperuricosuria (in 2-10%) and Cystinuria (in 6%). Conclusion Pediatricians need a high level of clinical suspicion to diagnose urinary stone because of its non-classical and often obscure manifestations in children. Imaging must be performed with care and stringency in pediatric patients to avoid any excessive or unnecessary exposure to radiation. All children with urinary stones require a complete metabolic workup.
لغات کلیدی children, emergency, nephrolithiasis, urolithiasis
 
     
     
 
 
     
     
 
 
     
     
 

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