To assess the association between serum and urinary metabolic abnormalities, stone recurrence risk, and patient and stone characteristics in calcium-based pediatric stone formers; aiming to refine the indication for metabolic evaluation in pediatric urolithiasis population. The study included 80 pediatric patients < 18 years with a history of intervention for calcium-based stones at the Urology and Nephrology Center, Mansoura University, Egypt, between 2001 and 2022. Electronic database was reviewed for patient and stone characteristics. Serum and 24-hour urinary metabolic evaluation was done. The primary outcome was to assess the association between serum and urinary metabolic abnormalities, and patient and stone characteristics. A secondary outcome was to assess risk factors associated with stone recurrence. Serum and urinary metabolic abnormalities were present in 31.25% and 73.75% of the study population, respectively. There was no significant difference between normal and abnormal groups of serum and 24-hour urine chemistry in relation to all assessed patient and stone characteristics. However, there was a significant association between stone laterality and risk of recurrence (HR: 3.801, 95% CI: 1.239–11.662, p = 0.02); being ~ 3.8 times higher with bilateral urolithiasis (78.3% vs. 21.8% with unilateral urolithiasis). Routine serum and 24-hour urinary metabolic evaluation is still indicated in all pediatric calcium-based stone formers; being a high-risk population. However, the recurrence risk is higher in patients with bilateral urolithiasis. So, in case of limited resources, metabolic evaluation could be restricted to this group of patients only.
Sobh et al. (Thu,) studied this question.