Çocuklarda Üriner Sistem Taş Hastalığına Yaklaşım
Synopsis
Urinary tract stone disease, whose incidence in children has increased from 4% to 10% over the last 20 years, is detected at a rate of 0.8% among school-age children in Turkey. In stone formation, supersaturation—resulting from decreased urine volume, increased calcium, oxalate, uric acid, and cystine, and decreased protective substances like citrate and magnesium—along with Randall's plaques formed in the loop of Henle, plays the main role. Insufficient fluid intake, diet, genetic factors (33% family history), urinary pH shifts, urinary anomalies, and infections, as well as metabolic disorders observed in 75-84% of pediatric cases, are the primary causative factors. While calcium stones (45-65% calcium oxalate, 15% calcium phosphate) are most commonly observed, struvite (3-30%), cystine, and uric acid stones (5-10%) are rarer. Symptoms manifest as flank/abdominal pain and hematuria in older children, whereas vomiting, irritability, and loss of appetite predominate in younger children. Ultrasonography is the first choice in diagnosis, while non-contrast computed tomography is the gold standard. Treatment begins with high fluid intake (1.5-2 L/m²/day) and dietary sodium restriction, followed by medical agents such as thiazides, potassium citrate, or allopurinol depending on the etiology. For stones that do not pass spontaneously or cause obstruction, minimally invasive surgical procedures such as ESWL, ureteroscopy (URS), retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL) are applied. Because stone disease carries a high risk of recurrence, post-acute follow-up based on underlying metabolic factors is essential.
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