Comparison of Risk Factors for Pediatric Kidney Stone Formation: The Effects of Sex

Frontiers in Pediatrics

article

Andrew L. Schwaderer¹  Rupesh Raina²  Anshika Khare³  Fayez Safadi³  Sharon M. Moe⁴  Kirsten Kusumi² 

[1] Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, United States;Division of Nephrology, Akron Children's Hospital, United States;Northeast Ohio Medical University, United States;Division of Nephrology, Department of Medicine, Indiana University School of Medicine, United States

关键词: urolithiasis;    kidney stones;    pediatrics;    sex;    age;   

DOI  :  10.3389/fped.2019.00032

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Urinary stones are affecting more children, and pediatric stone formers have unique pathophysiology compared to adults. While adult stone formers are most frequently male, children have an age dependent sex prevalence. Under 10 years, a majority of stone formers are boys; adolescent stone formers are mostly female. Previous adult studies have shown that stone composition is influenced by the sex and age of the stone former. Thus, we hypothesize that female and male stone forming children will also have sex and age specific stone phenotypes. Methods: Retrospective chart review of a large pediatric center's stone forming children 6/1/2009 to 6/1/2016. Patients were identified by ICD 9 codes: N20, N20.1, and N20.9. Charts were reviewed for radiographic evidence of stones or documented visualized stone passage. Results: One hundred and thirty six subjects: 54 males and 82 females. Females were older, median age 14 years [interquartile range (IQR): 11, 15] vs. males' median age 12 years (IQR: 11, 14) ( p < 0.01). Females had lower height z -scores, median 0.2 (IQR: −0.8, 0.8) vs. males' median 0.8 (IQR: −0.2, 1.8) ( p < 0.01). Presenting symptoms were similar except flank pain affecting 39% of females vs. 22% of males ( p = 0.04). Leukocyte esterase was positive in more females than males (33 vs. 4%) ( p < 0.001). Males had a higher BUN/Cr ratio, mean ± standard deviation of 19.8 ± 6.3 vs. 16.6 ± 6.5 in females ( p = 0.01). Glomerular hyperfiltration was present in 9% of patients while 35% of patients had estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m 2 . Treatment strategies and clinical course were similar except females were told to increase dietary citrate more frequently than males (21 vs. 4%) ( p < 0.01). Conclusion: We have provided a novel analysis and demonstrated that low height z -score and pyuria are more common in female stone formers. We have also shown that 9% of pediatric stone formers have labs consistent with hyperfiltration. Whether high protein intake and/or chronic dehydration are associated with hyperfiltration and long-term renal function in children with kidney stones will be an area for future research.

【 授权许可】

CC BY