Nephro-urolithiasis

Abstract

Nephro-urolithiasis is increasingly diagnosed in children, and it is an important cause of morbidity worldwide. Most common risk factors are infection and metabolic diseases.

Its clinical presentation varies, and in young children, we do not observe the classic acute onset of flank pain commonly seen in adults, but vague abdominal pain, hematuria, and urinary tract infection are more common.

As a result, children are frequently evaluated for other conditions before the diagnosis of nephrolithiasis is made. However a prompt diagnosis in an acute phase is crucial to exclude subsequent complications including renal failure.

At imaging examinations, calculi are usually visible on plain radiographs, but sometimes they cannot be identified, either because they are radiolucent or obscured by overlying bowel gas or feces. Ultrasound (US) is the first imaging modality in children with suspected renal tract calculosis. Complications such as obstruction and subsequently dilatation of the proximal upper tract might be visible at US. In children presenting with symptoms suggestive of urolithiasis and a negative US, plain film radiographs or an unenhanced computed tomography (CT) should be performed for confirmation or exclusion. This latter examination might be especially useful for the diagnosis of very small calculi and calculi with poor radiographic density, but should be considered as the last choice due to higher radiation exposure.