Kidney Stone Recurrence among Children and Adolescents.
Year of Publication
2016 Aug 10
<p><strong>PURPOSE: </strong>Kidney stone disease has become increasingly common during childhood and adolescence; however, the rate of symptomatic kidney stone recurrence for pediatric patients is uncertain.</p>
<p><strong>MATERIALS AND METHODS: </strong>We performed a retrospective cohort study of patients aged 3-18 years without anatomic abnormalities or genetic causes of nephrolithiasis who presented with a first symptomatic kidney stone between 2008 and 2014. We determined recurrence rates of symptomatic nephrolithiasis, defined as a new kidney stone on ultrasound and/or CT associated with pain and/or vomiting. We also estimated associations between completing 24-hour urine analyses and symptomatic kidney stone recurrence using Kaplan-Meier curves and multivariable Cox regression models.</p>
<p><strong>RESULTS: </strong>Among 285 children with a median age at nephrolithiasis diagnosis of 14.8 years (IQR 11.3-16.6) who were followed for 492 person-years, 68 patients (24%) developed 86 symptomatic recurrent stones over the follow-up period. The probability of symptomatic stone recurrence was 50% three years after the index kidney stone. The median time to stone recurrence was 3 and 5 years to the first and second stone recurrence, respectively. Adjusting for confounders, including adherence to follow-up, completing a 24-hour urine analysis after a kidney stone episode was associated with a 60% decreased risk of recurrence (hazard ratio 0.40; 95% CI, 0.18-0.91).</p>
<p><strong>CONCLUSIONS: </strong>The risk of kidney stone recurrence is high during childhood, with approximately 50% presenting with a symptomatic recurrence within three years of the first stone. The role and utility of analyzing 24-hour urine chemistries in decreasing kidney stone recurrence should be explored in future prospective studies.</p>