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Please Note: The following guideline has not been assessed using the AGREE (Appraisal of Guidelines for Research and Evaluation) criteria. This will be utilised at the next review of this guideline.
The following guideline has been developed by Clinicians within the Renal Unit, Yorkhill. This document is intended for use by clinicians in the Management and Evaluation of Nephrolithiasis/Nephrocalcinosis.
Nephrolithiasis or renal stone disease remains a significant health problem in the adult population but the frequency in childhood is much less. The term nephrocalcinosis (NC) implies an increase in calcium content in the kidney and may coexist with nephrolithiasis. NC occurs less frequently than nephrolithiasis and may be focal, occurring in an area of previously damed parenchyma or generalised usually as a result of underlying metabolic disorder in which it is most prominent in the renal medulla. In practice the commonest cause of NC is associated with pre term delivery where the aetiology is likely to be related to the hypercalciuric effect of loop diuretic therapy perhaps in combination with corticosteroids and Methylxanthines. Other causes are hypercalcaemic states, e.g. hyperparathyroidism, vitamin D intoxication, prolonged immobilisation, idiopathic hypercalcaemia and tumour related hypercalcaemia.
The incidence and aetiology of renal stones differs significantly amongst different geographical regions. In European children infection related stones predominate and these are located in the upper urinary tract and are composed of struvite (magnesium, ammonium, calcium phosphate) and are frequently related to proteus UTI. Hypercalciuria is the most common metabolic cause of stones in Western children but no diagnosis is determined in around a third of patients. North American data of analysed stones suggest the frequency and composition of urinary tract stones as:
NC is generally asymptomatic unless associated with nephrolithiasis and the latter presents with abdominal or flank pain, micro/macroscopic haematuria and UTI.
Evaluation of patient with NC and nephrolithiasis is similar:
Urinalysis and pH |
If spot urines are abnormal, a second voided EMU should be taken and subsequently a 12-14hr collection |
Urine Culture |
|
Urinary calcium, oxalate and urate creatinine ratios |
|
Urinary amino acid and organic acid screen |
Age Range |
Values |
Birth to 6 months |
< 2.42 mmol/mmol creatinine |
7 – 12 months |
0.09 – 2.2 |
1 – 2 years |
0.07 – 1.5 |
2 – 3 years |
0.06 – 1.4 |
3 – 5 years |
0.05 – 1.1 |
5 – 7 years |
0.04 – 0.8 |
>7 years |
0.04 – 0.7 |
Age Range |
Values |
< 1 week |
0.12 – 1.96 mmol/mmol creatinine |
1 – 2 years |
0.42 – 1.53 |
2 – 6 years |
0.57 – 1.35 |
6 – 10 years |
0.39 – 0.85 |
10 – 18 years |
0.15 – 0.67 |
18 years> |
0.11 – 0.53 |
Age Range |
Values |
< 1 month |
0.061 – 0.28 mmol/mmol creatinine |
1 month – 1 year |
0.04 – 0.23 |
1 – 12 years |
0.057 – 0.136 |
Last reviewed: 01 January 2011
Next review: 30 December 2015
Author(s): Renal Clinicians Group
Approved By: Clinical Effectiveness