Tamsulosin for Ureteral Stones -- Use in a Pediatrics?
Urolithiasis had been a diagnosis made mostly in the adult population. The incidence of nephrolithiasis in children has increased during the last decade (VanDervoort et al., 2007). In the United States, every one in 685 pediatric hospitalizations are due to stones (Bush et al., 2010). In North America, 7% of kidney stones occur in children younger than 16 years of age with a maleto-female ratio of approximately 1 to 1.5:1 (Edvardsson, Elidottir, Indridason, & Palsson, 2005). The lifetime prevalence of kidney stones has increased over the past three decades from 3.2% to 5.2%, and the probability of recurrence is about 50% (Goldfarb, 2003; Teichman, 2004).
Working in an academic center in a large city, it has been the experience of these authors that stones in the pediatric population have increased during the previous 10 years. At the authors' facility, 10 to 15 pediatric patients with kidney stones are seen and treated each week, whereas 10 years ago, the same number of cases were seen and treated in one year. Despite the lower prevalence and incidence in the pediatric population when compared to the adult population, kidney stones in children have been associated with high rates of recurrence (Pietrow et al., 2002). Both the environment and one's genetic makeup can cause kidney stones (Sayer, 2008). Low fluid intake (dehydration) and high specific gravity can increase the likelihood of crystallization and stone formation (Schwartz & Dwyer, 2006). An adequate amount of water is necessary for the kidneys to completely dissolve waste products; if there is not enough water, the kidneys cannot completely dissolve substances (calcium, oxalate, uric acid), which can contribute to the crystallization/formation of kidney stones. Low levels of citrate can also increase the risk of stone burden. Citrate is a molecule that binds to calcium in the urine and prevents calcium from binding to other stone-forming chemical substances, such as oxalate and phosphate. High concentrations of citrate can be found in citrus fruits, such as lemons and limes. Dietary factors, which tend to increase urinary calcium excretion, include excessive animal protein, high sodium, caffeine intake, and low dietary fiber (Sayer, 2008). There are also nonmodifiable risk variables, such as genetic factors, and metabolic and congenital abnormalities. In a study conducted by Milliner and Murphy (1993), 75% of their 221 pediatric patients had predisposing factors for stone formation, including metabolic abnormalities, infection, obstruction, or structural anomalies.
Increasing Pediatric Incidence
Urolithiasis had been a diagnosis made mostly in the adult population. The incidence of nephrolithiasis in children has increased during the last decade (VanDervoort et al., 2007). In the United States, every one in 685 pediatric hospitalizations are due to stones (Bush et al., 2010). In North America, 7% of kidney stones occur in children younger than 16 years of age with a maleto-female ratio of approximately 1 to 1.5:1 (Edvardsson, Elidottir, Indridason, & Palsson, 2005). The lifetime prevalence of kidney stones has increased over the past three decades from 3.2% to 5.2%, and the probability of recurrence is about 50% (Goldfarb, 2003; Teichman, 2004).
Working in an academic center in a large city, it has been the experience of these authors that stones in the pediatric population have increased during the previous 10 years. At the authors' facility, 10 to 15 pediatric patients with kidney stones are seen and treated each week, whereas 10 years ago, the same number of cases were seen and treated in one year. Despite the lower prevalence and incidence in the pediatric population when compared to the adult population, kidney stones in children have been associated with high rates of recurrence (Pietrow et al., 2002). Both the environment and one's genetic makeup can cause kidney stones (Sayer, 2008). Low fluid intake (dehydration) and high specific gravity can increase the likelihood of crystallization and stone formation (Schwartz & Dwyer, 2006). An adequate amount of water is necessary for the kidneys to completely dissolve waste products; if there is not enough water, the kidneys cannot completely dissolve substances (calcium, oxalate, uric acid), which can contribute to the crystallization/formation of kidney stones. Low levels of citrate can also increase the risk of stone burden. Citrate is a molecule that binds to calcium in the urine and prevents calcium from binding to other stone-forming chemical substances, such as oxalate and phosphate. High concentrations of citrate can be found in citrus fruits, such as lemons and limes. Dietary factors, which tend to increase urinary calcium excretion, include excessive animal protein, high sodium, caffeine intake, and low dietary fiber (Sayer, 2008). There are also nonmodifiable risk variables, such as genetic factors, and metabolic and congenital abnormalities. In a study conducted by Milliner and Murphy (1993), 75% of their 221 pediatric patients had predisposing factors for stone formation, including metabolic abnormalities, infection, obstruction, or structural anomalies.
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