A STUDY ON THE RATE, TYPE AND CLINICAL FEATURES OF UROLITHIASIS IN CHILDREN YOUNGER THAN 15 YEARS WITH SYMPTOMATIC URINARY TRACT INFECTION

Marked variation exists in the incidence of urolithiasis in children worldwide. Urolihiasis may be declared by the passage of stone, but is more commonly revealed during the investigation of a child for urinary tract infection (UTI). The aim of this study was to determine the rate of renal calculi in patients with symptomatic UTI. Over an eight months period, 196 children (aged two months to 15 years) admitted with symptomatic UTI; were evaluated for renal calculi by plain abdominal x-ray and ultrasonography. The results showed that 15 (7.6 %) had urolithiasis which was more common in boys. Fever and dysuria were the commonest clinical features in 80% of cases. The implicated organisms isolated in both UTI and urolithiasis were as following: E.Coil (67 %), Klebseilla (26 %) and Proteus (7%). Obstructive hydronephrosis was detected in 40 % of cases leading to surgical intervention. The sites of stones were as follow: upper urinary (67 %), bladder (20 %), and urethra (13 %). Stone analysis was done in 12 cases revealing calcium oxalate in 8 (53 %), cysine in 2 (13 %), struvite and uric acid 1 (6.7 %) in each. In 80 % of patients, the stones were multiple and 66.6 % were bilateral. In 50 % of cases, the underlying disorders were identified. Two cases had distal renal tubular acidosis, Two brothers had cystinuria and one child had a staghorn struvite. On admission, 40 % of our cases had an obstruction and 27 % of them had ARF who on discharge had better renal function following treatment with antimicrobial drugs. These findings suggest that early diagnosis and management of renal stones in children with UTI is necessary to prevent the development of renal failure.