AETIOPATHOGENESIS,DIAGNOSIS
AND MANAGEMENT OF
UROLITHIASIS IN CHILDREN
BY
IMOUDU I A
MODERATOR PROF AIKHIONBARE H A
OUTLINE
• INTRODUCTION
• EPIDEMIOLOGY
• AETIOPATHOGENESIS
• CLINICAL PRESENTATION
• DIAGNOSIS
• MANAGEMENT
• PROGNOSIS
• C...
INTRODUCTION
• THE EXISTENCE OF CALCULI IN THE URINARY
TRACT HAS BEEN RECORDED SINCE THE
BEGINNING OF CIVILIZATION
• LITHO...
INTRODUCTION
• MEDICAL TEXTS FROM ANCIENT MESOPOTAMIA,
INDIA,CHINA,PERSIA,GREECE & ROME ALL
MENTIONED CALCULOUS DISEASE
• ...
EPIDEMIOLOGY
• GLOBAL DISEASE
• COMMONER IN EASTERN EUROPE,SOUTHEAST
ASIA,INDIA & THE MIDDLE EAST
• IN RSA IT IS COMMONER ...
EPIDEMIOLOGY
• AFFECTS ALL AGE GROUPS
• RARE IN CHILDREN - 7% OF ALL CASES
• COMMONER IN BOYS 3:2
• ADULTS,M/F 4:1
AETIOPATHOGENESIS
• THERE IS CONTINUOUS INTERACTION B/W
FACTORS THAT PROMOTE & THOSE THAT
INHIBIT CRYSTALLIZATION IN THE F...
AETIOPATHOGENESIS
CRYSTALS EVOLVE IN THE PRESENCE OF SUBSTANCES
LIKE
• Ca-OXALATE
• CaCO3
• Mg
• NH4
• PO4
• URIC ACID
AETIOPATHOGENESIS
STONES IN URINARY TRACT COMMONLY COMPOSE
OF
• Ca-OXALATE/CaPO4 75-80%
• STRUVITE 15%
• URIC ACID 7%
• CY...
AETIOPATHOGENESIS
RISK FACTORS
• DEHYDRATION
• INFECTION
• CHANGES IN URINE pH
• OBSTRUCTION OF URINE FLOW
• IMMOBILIZATIO...
AETIOPATHOGENESIS
SOME ASSOCIATED METABOLIC CONDITIONS
• HYPERVITAMINOSIS D
• HYPEROXALURIA
• RENAL TUBULAR ACIDOSIS(TYPE ...
Kidney stone
Classification and external resources
CLINICAL PRESENTATION
• COLICKY ABDOMINAL PAIN
• HAEMATURIA
• DYSURIA
• FEVER
• DRIBBLING OF URINE
• WEIGHT LOSS
• PYURIA
...
DIAGNOSIS
• PLAIN ABDOMINAL X-RAY
• CT-SCAN
• ABDOMINAL ULTRASOUND SCAN
• URINALYSIS
• URINE M/C/S
• U/E+CREATININE,Ca
DIAGNOSIS
• FBC+DIFF
• 24HR URINE COLLECTION FOR Mg,Na,Ca,URIC
ACID,CITRATE,OXALATE & PO4
• CATCHING OF PASSED STONES FOR ...
MANAGEMENT
MEDICAL
• TREAT UNDERLYING METABOLIC DISEASE
• ADEQUATE HYDRATION
• DIETARY MODIFICATION
• ALPHA ADRENERGIC BLK...
MANAGEMENT
SURGICAL
INDICATIONS FOR SURGERY;
• PERSISTENT & SEVERE PAIN
• RENAL INFECTION
• RENAL FAILURE
• FAILURE OF MED...
MANAGEMENT
SURGICAL PROCEDURES
• LITHOTRIPSY- ESWL
• ENDOSCOPIC FRAGMENTATION
• PERCUTANEOUS NEPHROLITHOTOMY
• LITHOTOMY
PROGNOSIS
• USUALLY NOT FATAL
• 90% OF STONES 4mm OR LESS IN SIZE PASS
SPONTANEOUSLY
• DEATH MAY RESULT FROM COMPLICATIONS...
• Emperor of france 1804- 1815
• Nepoleon 111 ruler of france 1850-1870
• Sir isaac newton 1642- 1727
• Lyndon B Johnson president from 1963- 1969
CONCLUSION
• THOUGH A VERY RARE CONDITION AMONG
CHILDREN IN THIS ENVIRONMENT,THOSE
WHO DEVELOP VERY PAINFUL STONES MAY
EXP...
THANK
YOU
REFERENCES
• Kliegman RM et al; Nelson Textbook of
Pediatrics,18th edition 2008;539:1822-26
• Encyclopaedia Britannica 200...
REFERENCES
• Bushinsky DA.Nephrolithiasis J. Am Soc
Nephrol.1998;8:917-24
• Cochat P,Basmaism O.Current approaches to the
...
REFERENCES
• Abubakar AM,Mungadi IA,Chinda JY,Ntia IO,Jalo
I,Obiano SK.Paediatric Urolithiasis in Northern
Nigeria.African...
Imoudu 2
Imoudu 2
Imoudu 2
Upcoming SlideShare
Loading in...5
×

Imoudu 2

183

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
183
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Imoudu 2

  1. 1. AETIOPATHOGENESIS,DIAGNOSIS AND MANAGEMENT OF UROLITHIASIS IN CHILDREN BY IMOUDU I A MODERATOR PROF AIKHIONBARE H A
  2. 2. OUTLINE • INTRODUCTION • EPIDEMIOLOGY • AETIOPATHOGENESIS • CLINICAL PRESENTATION • DIAGNOSIS • MANAGEMENT • PROGNOSIS • CONCLUSION
  3. 3. INTRODUCTION • THE EXISTENCE OF CALCULI IN THE URINARY TRACT HAS BEEN RECORDED SINCE THE BEGINNING OF CIVILIZATION • LITHOTOMY FOR THE REMOVAL OF STONES IS ONE OF THE EARLIEST KNOWN SURGICAL PROCEDURES • A PELVIC STONE DATING BACK TO 4800BCE WAS DISCOVERED IN AN EGYPTIAN MUMMY IN 1901
  4. 4. INTRODUCTION • MEDICAL TEXTS FROM ANCIENT MESOPOTAMIA, INDIA,CHINA,PERSIA,GREECE & ROME ALL MENTIONED CALCULOUS DISEASE • PART OF THE HIPPOCRATIC OATH CONTAINS AN ADMONITION ABOUT THE DANGERS OF OPERATING ON THE BLADDER FOR STONES
  5. 5. EPIDEMIOLOGY • GLOBAL DISEASE • COMMONER IN EASTERN EUROPE,SOUTHEAST ASIA,INDIA & THE MIDDLE EAST • IN RSA IT IS COMMONER IN WHITES • IN USA IT IS COMMONER IN WHITES THAN BLACKS,ASIAN & LATIN AMERICANS
  6. 6. EPIDEMIOLOGY • AFFECTS ALL AGE GROUPS • RARE IN CHILDREN - 7% OF ALL CASES • COMMONER IN BOYS 3:2 • ADULTS,M/F 4:1
  7. 7. AETIOPATHOGENESIS • THERE IS CONTINUOUS INTERACTION B/W FACTORS THAT PROMOTE & THOSE THAT INHIBIT CRYSTALLIZATION IN THE FLUIDS OF THE URINARY TRACT • STONES FORM AROUND A NUCLEUS OR NIDUS
  8. 8. AETIOPATHOGENESIS CRYSTALS EVOLVE IN THE PRESENCE OF SUBSTANCES LIKE • Ca-OXALATE • CaCO3 • Mg • NH4 • PO4 • URIC ACID
  9. 9. AETIOPATHOGENESIS STONES IN URINARY TRACT COMMONLY COMPOSE OF • Ca-OXALATE/CaPO4 75-80% • STRUVITE 15% • URIC ACID 7% • CYSTINE 1% • OTHERS <1%
  10. 10. AETIOPATHOGENESIS RISK FACTORS • DEHYDRATION • INFECTION • CHANGES IN URINE pH • OBSTRUCTION OF URINE FLOW • IMMOBILIZATION • DIET • GOUT • FAT MALABSORPTION
  11. 11. AETIOPATHOGENESIS SOME ASSOCIATED METABOLIC CONDITIONS • HYPERVITAMINOSIS D • HYPEROXALURIA • RENAL TUBULAR ACIDOSIS(TYPE 1) • HYPERURICOSURIA • HYPOCITRURIA • CYSTINURIA • SARCOIDOSIS
  12. 12. Kidney stone Classification and external resources
  13. 13. CLINICAL PRESENTATION • COLICKY ABDOMINAL PAIN • HAEMATURIA • DYSURIA • FEVER • DRIBBLING OF URINE • WEIGHT LOSS • PYURIA • OLIGURIA • ANOREXIA • VOMITING
  14. 14. DIAGNOSIS • PLAIN ABDOMINAL X-RAY • CT-SCAN • ABDOMINAL ULTRASOUND SCAN • URINALYSIS • URINE M/C/S • U/E+CREATININE,Ca
  15. 15. DIAGNOSIS • FBC+DIFF • 24HR URINE COLLECTION FOR Mg,Na,Ca,URIC ACID,CITRATE,OXALATE & PO4 • CATCHING OF PASSED STONES FOR ANALYSIS • IVU
  16. 16. MANAGEMENT MEDICAL • TREAT UNDERLYING METABOLIC DISEASE • ADEQUATE HYDRATION • DIETARY MODIFICATION • ALPHA ADRENERGIC BLKERS; TAMSULOSIN,TERAZOSIN,DOXAZOSIN • Ca CHANNEL BLKERS • ALKALIZATION/ACIDIFICATION OF URINE • ANALGESIA
  17. 17. MANAGEMENT SURGICAL INDICATIONS FOR SURGERY; • PERSISTENT & SEVERE PAIN • RENAL INFECTION • RENAL FAILURE • FAILURE OF MEDICAL MANAGEMENT
  18. 18. MANAGEMENT SURGICAL PROCEDURES • LITHOTRIPSY- ESWL • ENDOSCOPIC FRAGMENTATION • PERCUTANEOUS NEPHROLITHOTOMY • LITHOTOMY
  19. 19. PROGNOSIS • USUALLY NOT FATAL • 90% OF STONES 4mm OR LESS IN SIZE PASS SPONTANEOUSLY • DEATH MAY RESULT FROM COMPLICATIONS &/OR UNDERLYING CAUSE
  20. 20. • Emperor of france 1804- 1815
  21. 21. • Nepoleon 111 ruler of france 1850-1870
  22. 22. • Sir isaac newton 1642- 1727
  23. 23. • Lyndon B Johnson president from 1963- 1969
  24. 24. CONCLUSION • THOUGH A VERY RARE CONDITION AMONG CHILDREN IN THIS ENVIRONMENT,THOSE WHO DEVELOP VERY PAINFUL STONES MAY EXPERIENCE SIGNIFICANT MORBIDITY • THERE MAY BE NEED FOR A HIGH INDEX OF SUSPICION,ESPECIALLY IN PRE-SCHOOL AGE CHILDREN WITH RECURRENT ABDOMINAL PAIN
  25. 25. THANK YOU
  26. 26. REFERENCES • Kliegman RM et al; Nelson Textbook of Pediatrics,18th edition 2008;539:1822-26 • Encyclopaedia Britannica 2008 • William W Hay Jr,et al;Current Pediatric Diagnosis and treatment 18th edition 2007;22:728-29 • http//en. Wikipedia.org • http//www.eMedicine.com • Hulton SA.Evaluation of Urinary tract Calculi in children.Arch.Dis.child.2001;84:320-23
  27. 27. REFERENCES • Bushinsky DA.Nephrolithiasis J. Am Soc Nephrol.1998;8:917-24 • Cochat P,Basmaism O.Current approaches to the management of primary hyperoxaluria.Arch Dis child 2000;82:470-73 • Ronnenfarth G,Musselwitz J.Nephrocalcinosis in children:A retrospective survey.Pediatr Nephrol 2000;14:1016-21 • EL-Damanhoury H,Burger R,Hanhefeller R.Surgical aspects of Urolithiasis in children.Pediatr.Nephrol 1991;5:339-47
  28. 28. REFERENCES • Abubakar AM,Mungadi IA,Chinda JY,Ntia IO,Jalo I,Obiano SK.Paediatric Urolithiasis in Northern Nigeria.African Journal of Paediatric Surgery.2004;1:2-5 • Angwafo FF et al.Paediatric Urolithiasis in Subsaharan Africa:A comparative study in two regions of Cameroun.Eur.Urol.2000;37:106-11
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×