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Good Morning and Welcome Applicants!. January 27, 2011. Epidemiology . 1/685 pediatric admissions Lower incidence than adults Higher crystal formation inhibitors in urine M>F Most common stones Calcium oxalate Calcium phosphate Struvite Cystine Uric Acid. Risk Factors. - PowerPoint PPT PresentationTRANSCRIPT
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Good Morning and Welcome Applicants!
January 27, 2011
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Epidemiology 1/685 pediatric admissionsLower incidence than adults
Higher crystal formation inhibitors in urine
M>FMost common stones
Calcium oxalate Calcium phosphateStruviteCystine Uric Acid
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Risk FactorsPresent in 75-85% of childrenUrinary metabolic abnormality
Hypercalciuria*HyperoxaluriaHyperuricosuriaHypocitraturia
UTIStructural renal or urinary tract abnormality
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Nephrolithiasis PresentationAbdominal or flank pain
Wide variabilityGross hematuriaDysuriaUrgencyNausea/vomiting 15-20% asymptomatic
Younger patients
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Other HistoryPrevious historyFamily historyUnderlying renal and urinary tract structural
abnormalitiesUnderlying metabolic conditionsMedication useHistory of UTI
Especially with urease-producing organisms Proteus or Klebsiella
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Physical ExamGrowth parameters
Congenital or chronic conditionTemperature
UTIBlood pressure
Glomerular disease Edema
AbdomenTendernessMass
Obstruction
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Lab EvaluationUA
Sediment Cystine crystals Calcium oxalate Calcium phosphate Uric acid Phosphate
Urine Culture
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DiagnosisConfirmation
Imaging Non-contrast helical CT Ultrasonography
Stones >5mm Location
Plain abdominal radiography Radiopaque only Not good for small stones
Retrieval
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TreatmentHospitalization
Nausea/vomitingSevere painUrinary obstructionSolitary kidneyInfection
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TreatmentPain control
NSAIDsOpiod therapyCombination may be
superiorPassage
<5 mmHydrationStrain urine
Stone analysis
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TreatmentUrologic intervention
Unremitting severe painUrinary obstructionInfection Renal insufficiency>5mm stoneStruvite calculi>2 weeks of conservative treatment
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TreatmentUrological
interventionExtracorporeal shock
wave lithotripsy Small <1cm
Percutaneous nephrostolithotomy >2cm Structural
abnormalities Harder stones
Ureteroscopy
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PreventionRecurrent stone disease frequently occurs in
children>50% of children with nephrolithiasis will
have an underlying metabolic abnormalityReduce
PainSchool absenteeismLoss of work for parentsClinical costs
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PreventionStone analysis
Focus metabolic evaluation
Metabolic evaluationAt homeFully ambulatoryRegular dietFree of infection
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PreventionSerum testing
CalciumPhosphorusBicarbonateCreatinineMagnesiumUric Acid
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PreventionUA
SpGrpHCrystals
Urine solute excretion24h vs singleVolume and creatinine
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PreventionFluid intake
Metabolic interventionsTargeted to correct the specific abnormality
Infants >750ml/day<5y >1L/day
5-10y >1.5L/day>10y >2L
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MonitoringImaging
New formation or increasing size of previous stones
U/SFrequency depends on risk
Lab evalAssess response to preventative therapy6-8 weeks, 6 months, yearly