Urolithiasis in the pediatric population − Current opinion on epidemiology, patophysiology, diagnostic evaluation and treatment

Urolithiasis, a condition in which calculi are found in the urinary tract, has been known for centuries. Although the disease was considered casuistic in the pediatric population, its prevalence is rising among both children and infants. The occurrence of the disease is greater in developed countries, therefore urolithiasis should be considered a lifestyle disease. Its etiopathogenesis has not yet been well understood. Kidney stone formation is influenced by factors such as climate, eating habits, profession, fluid intake, genetic predisposition, urinary tract infections and malformations of the urinary tract. Calculi are usually composed of mixed mineral substances. Only about 30% are made up of one chemical substance, calcium oxalate being the most common. Urolithiasis can be asymptomatic and accidentally diagnosed. Abdominal pain is the most common clinical symptom, however disease presentation among infants is nonspecific. Hematuria is a common clinical finding. Ultrasonography is the most important diagnostic tool in the diagnosis of kidney stone disease. Metabolic evaluation is required in every case of urolithiasis in the pediatric population, as metabolic disorders can be found in the majority of cases in this age group. The spontaneous passage of calculi less than 6mm in diameter is likely. Invasive treatment should be carried out if stones exceed 6mm in diameter or fail to expulse spontaneously. Prophylactic treatment includes adequate fluid intake, healthy eating habits and physical activity to maintain a healthy weight. Urolithiasis is a recurrent disease, therefore long-term treatment, prophylaxis and a lasting change in dietary habits are essential.