بررسي شيوع ، نوع و علايم سنگ هاي ادراري در كودكان كمتر از 15 سال مبتلا به عفونت ادراري علامت دار

A STUDY ON THE RATE, TYPE AND CLINICAL FEATURES OF UROLITHIASIS IN CHILDREN YOUNGER THAN 15 YEARS WITH SYMPTOMATIC URINARY TRACT INFECTION

Objective: Marked variation exists in the incidence of urolithiasis in children worldwide. Urolihiasis may be declared by the passage of stone, but is more commonly revealed during the investigation of a child for urinary tract infection (UTI). The aim of this study was to determine the rate of renal calculi in patients with symptomatic UTI. Methods: Over an eight months period, 196 children (aged two months to 15 years) admitted with symptomatic UTI; were evaluated for renal calculi by plain abdominal x-ray and ultrasonography. Results: The results showed that 15 (7.6 %) had urolithiasis which was more common in boys. Fever and dysuria were the commonest clinical features in 80% of cases. The implicated organisms isolated in both UTI and urolithiasis were as following: E.Coil (67 %), Klebseilla (26 %) and Proteus (7%). Obstructive hydronephrosis was detected in 40 % of cases leading to surgical intervention. The sites of stones were as follow: upper urinary (67 %), bladder (20 %), and urethra (13 %). Stone analysis was done in 12 cases revealing calcium oxalate in 8 (53 %), cysine in 2 (13 %), struvite and uric acid 1 (6.7 %) in each. In 80 % of patients, the stones were multiple and 66.6 % were bilateral. In 50 % of cases, the underlying disorders were identified. Two cases had distal renal tubular acidosis, Two brothers had cystinuria and one child had a staghom struvite. On admission, 40 % of our cases had an obstruction and 27 % of them had ARF who on discharge had better renal function following treatment with antimicrobial drugs. Conclusion: These findings suggest that early diagnosis and management of renal stones in children with UTI is necessary to prevent the development of renal failure.