Summary
Purpose
Medically complex, non-ambulatory children can often suffer from nephrolithiasis.
The purpose of this study is to determine risk factors which are predictive for recurrent
stone formation in this patient population.
Material and methods
A retrospective cohort study was performed on non-ambulatory patients with cerebral
palsy and/or severe developmental delay presenting to a high-volume Pediatric Stone
Center from 2015 to 2019. Two 24-hour urine collections were performed as a baseline
prior to pharmacotherapeutic and/or dietary intervention. Healthy stone-forming children
served as a control group.
Results
28 non-ambulatory subjects and 38 healthy controls were evaluated. The study group
had a higher rate of bilateral nephrolithiasis but a similar history of previous surgical
procedures. 89% of the non-ambulatory children were fed via a gastrostomy. The median
calcium excretion was the same in both groups (3.0 mg/kg/day). The median 24-hour
excretion of oxalate was significantly increased in the study group (54 vs 31 mg/1.73 m2/day, p = 0.0001). Urinary citrate and phosphorus excretions, and the supersaturations
of calcium oxalate and calcium phosphate were similar between study subjects and controls.
Calcium oxalate stones were noted in 57% of those with known stone composition in
the study group. Enteral feeding formulas were primarily based on soy protein, a known
high oxalate food.
Conclusions
Urinary oxalate excretion is significantly increased in a cohort of medically complex,
non-ambulatory stone-forming children. Urinary calcium excretion was not elevated
between study subjects and healthy controls. Further analysis is needed to assess
if dietary intervention to limit oxalate excretion results in decreased stone formation.
Keywords
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References
- Pediatric stone disease.Urol Clin North Am. 2018; 45: 539-550
- Pediatric nephrolithiasis: a review.Pediatr Ann. 2017; 46: e242-e244
- Evaluation and medical management of kidney stones in children.J Urol. 2014; 192: 1329-1336
- Stone formation in patients less than 20 years of age is associated with higher rates of stone recurrence: results from the Registry for Stones of the Kidney and Ureter (ReSKU).J Pediatr Urol. 2020; 16: 373 e1-e6
- Urinary metabolic evaluations in solitary and recurrent stone forming children.J Urol. 2008; 179: 2369-2372
- The risk of recurrent urolithiasis in children is dependent on urinary calcium and citrate.Urology. 2010; 76: 242-245
- Urinary reference values for stone risk factors in children.J Urol. 2008; 179 (discussion 4): 290-294
- 24 Hour urine metabolic differences between solitary and multiple stone formers: results of the Collaboration on Urolithiasis in Pediatrics (CUP) working group.J Pediatr Urol. 2017; 13: 506 e1-e5
- Oxalate and phytate of soy foods.J Agric Food Chem. 2005; 53: 5670-5674
- Comparative analysis of nephrolithiasis in otherwise healthy versus medically complex gastrostomy fed children.J Pediatr Urol. 2011; 7: 244-247
- Relationships between enteral nutrition facts and urinary stones in a cohort of pediatric patients in rehabilitation from severe acquired brain injury.Clin Nutr. 2019; 38: 1240-1245
- Does a multidisciplinary pediatric stone center improve outcomes?.Urology Practice. 2020; 7: 362-367
- Evaluating pain in cerebral palsy: comparing assessment tools using the International Classification of Functioning, Disability and Health.Disabil Rehabil. 2019; 41: 2622-2629
- Effect of general anesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anesthetic implications of this coexisting disease.J Child Neurol. 2012; 27: 859-866
- The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders.World J Urol. 2013; 31: 1611-1615
- Immobilization induced hypercalcemia.Clin Cases Miner Bone Metab. 2016; 13: 46-47
- Calcium homeostasis in immobilization: an example of resorptive hypercalciuria.N Engl J Med. 1982; 306: 1136-1140
- Risk factors for urolithiasis in gastrostomy tube fed children: a case-control study.Pediatrics. 2013; 132: e167-e174
- Metabolic disturbances and renal stone promotion on treatment with topiramate: a systematic review.Br J Clin Pharmacol. 2014; 77: 958-964
- The role of the microbiome in kidney stone formation.Int J Surg. 2016; 36: 607-612
- Oxalate content of enteral nutrition formulas.J Pediatr Gastroenterol Nutr. 2019; 69: e135-e140
- Perturbations of the gut microbiome and metabolome in children with calcium oxalate kidney stone disease.J Am Soc Nephrol. 2020; 31: 1358-1369
- Effectiveness of treatment modalities on kidney stone recurrence.Clin J Am Soc Nephrol. 2017; 12: 1699-1708
- Pathophysiology and treatment of enteric hyperoxaluria.Clin J Am Soc Nephrol. 2021; 16: 487-495
Article info
Publication history
Published online: June 12, 2022
Accepted:
June 1,
2022
Received in revised form:
May 26,
2022
Received:
February 10,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Enteral feeding programs and hyperoxaluria: Is there a missing link?Journal of Pediatric UrologyVol. 18Issue 6
- PreviewChildren with complex medical conditions pose many difficulties in the evaluation and prevention of their nephrolithiasis episodes. DeFoor et al. present the next logical step in understanding the etiology of urinary stone disease in these children. The authors investigated the 24-h urine analyses of children with complex chronic conditions, many of whom depend upon enteral nutrition, and compared these to an unmatched cohort of otherwise healthy children with nephrolithiasis. While such an analysis is limited due to the retrospective and uncontrolled nature of the assessments, the difficulty in obtaining urine samples in such a population makes this study a valuable manuscript for future reference.
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