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