Natural history of patients with infantile nephrolithiasis: what are the predictors of surgical intervention?
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ORIGINAL ARTICLE
Natural history of patients with infantile nephrolithiasis: what are the predictors of surgical intervention? Seha Kamil Saygılı 1 & Elif Altınay Kırlı 2 & Emre Taşdemir 1 & Nur Canpolat 1 & Salim Çalışkan 1 & Lale Sever 1 & Zübeyr Talat 2 & Bülent Önal 2 Received: 7 April 2020 / Revised: 25 August 2020 / Accepted: 14 September 2020 # IPNA 2020
Abstract Background We evaluated the risk factors for the requirement of surgical intervention in infants with nephrolithiasis. Methods The medical records of 122 (156 kidney units (KU)) infants were reviewed. The clinical features, stone characteristics, changes in stone status, and treatment protocols were noted. The stone status of the KU was categorized into 3 groups according to the change in size between the first and last ultrasound: resolution, unchanged, and growth. Results The median age was 8 months (r: 2–12). The median length of follow-up was 16 months (r: 10–36). Resolution was detected in 94 KUs (60%). Stone growth was detected in 39 KUs (25%), and stone size was unchanged in 23 KUs (15%). Surgical intervention was required in 26 patients (17%). A history of intensive care unit (ICU) follow-up and a stone size > 5 mm at time of diagnosis were defined as independent risk factors for stone growth (p = 0.005, < 0.001, respectively). The surgical intervention rate was higher in stones > 5 mm and stones with pelvic localization (p = 0.018, 0.021, respectively). Stone resolution was higher in patients with stone size ≤ 5 mm (p = 0.018). Conclusion A stone size > 5 mm at the time of diagnosis and a history of ICU follow-up are independent risk factors for stone growth. Pelvic localization of stones and stones > 5 mm are associated with an increased risk of surgical intervention. Keywords Kidney stone . Infants . Surgery . Risk factors . Prematurity . ICU . Metabolic abnormality
Introduction Nephrolithiasis is a common problem in pediatric urology practice [1]. The incidence has increased among all ages, and approximately 20% of all pediatric patients are diagnosed in the infancy period [1–4]. Despite this increasing trend, there is limited information regarding infantile nephrolithiasis. In recent studies, a history of intensive care unit (ICU) followup, formula feeding, and multivitamin supplementation have been defined as predisposing factors [5, 6]. Although infantile Seha Kamil Saygılı and Elif Altınay Kırlı contributed equally to this work.
nephrolithiasis has been regarded as a benign condition due to its tendency to resolve [5, 6], Andrioli et al. reported that 15% of their patients underwent surgical intervention [7]. There are still no clearly recognized risk factors in the literature for patients with infantile nephrolithiasis that help to define who should undergo surgical intervention or who will experience resolution during follow-up. Furthermore, it is our clinical impression that this younger population may have different risk factors for stone growth than their older counterparts and that the rate of requirement for surgical inter
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