Çocukluk çağı üriner sistem taş hastalıklarında etiyolojik risk faktörleri, klinik bulgular ve tedaviye cevabın değerlendirilmesi
Etiological risk factors, clinical findings and evaluation of response to treatment in childhood urinary stone diseases
Yazar: NİMET ÖNER
Danışman: DOÇ. DR. FUNDA BAŞTUĞ
Sağlık Bilimleri Üniversitesi / Kayseri Şehir Hastanesi / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2019
Konu: Nefroloji = Nephrology ; Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases
Dizin: Hiperkalsiüri = Hypercalciuria ; Magnezyum = Magnesium ; Metabolizma = Metabolism ; Çocuklar = Children ; Üreter taşları = Ureteral calculi ; Üriner sistem = Urinary tract ; Üriner taşlar = Urinary calculi

Özet:
yüksekliği mikrolitiazisli olgularda, süt çocuklarında daha sık görüldüğü bulundu.
ÜSTH‟sı olan hastalara verilen en sık medikal tedavi K sitrat idi. Tüm taĢlı olgularda ve
mikrolitiazisi olanlarda düzelme oranları medikal tedavi verilmeyenlerde daha yüksekti.
Üst ve orta pol taĢlarının aksine alt pol taĢlarının tedavi ile düzelme oranları tedavisiz
düzelme oranlarına göre yüksek bulundu. Üst- orta pol taĢları ile alt pol taĢları
kıyaslandığında alt pol taĢlarında düzelme daha az oranda görüldü.
Sonuçlar: ÇalıĢmamızda, olguların büyük çoğunluğunda en az bir metabolik risk
faktörü tespit edildi. Mikrolitiazis olan hastaların büyük bir kısmının spontan olarak
düzeldiği tespit edildi. Bu nedenle bu grup hastada tedavi verilmesine gerek olmadığını
ama nadir de olsa taĢ boyutunda büyüme olabileceği için bu hastaların takip edilmesi
gerektiğini düĢünüyoruz. Alt pol taĢlarının düzelme oranları, üst-orta pol taĢlarına
oranla daha az olduğu için daha erken medikal tedaviye baĢlanmalıdır. Tüm taĢ
gruplarında tedavi verilmeyenlerde düzelme oranı daha yüksekti. Bunun nedeni tedavi
vermediğimiz olguların büyük çoğunluğunun mikrolitiazis olması, metabolik risk
faktörüne sahip olmaması ve üst ve orta pol taĢlarının olması olabilir. Tüm bulgular
ıĢığında taĢlı hastalarda taĢ boyutu >3mm ise, alt pol taĢı var ise ve metabolik risk
faktörü var ise medikal tedavi baĢlanmalıdır.
Anahtar Kelimeler; Üriner Sistem TaĢ Hastalığı, Hipomagnezüri, Hiperkalsiüri,
Metabolik Bozukluk

Abstract:
ABSTRACT
Introduction and Objective: Urinary tract stone disease (USTH) is an important
clinical problem with increasing incidence in children. Risk factors include metabolic
disturbances, genetic and anatomical abnormalities. The most important metabolic
causes are hypercalciuria and hypocitraturia. In order to reduce morbidity, it is very
important to determine the etiologic factors in the early period and start treatment. In
our study; The aim of this study was to evaluate the etiologic risk factors, initial clinical
findings and post-medical or surgical treatment processes in pediatric patients.
Materials and methods: The demographic data, medical anamnesis, clinical status,
etiologic risk factors, laboratory data, radiological findings and responses of the patients
who were admitted to our pediatric nephrology outpatient clinic between 2016-2018
were diagnosed with urinary stone disease. Data were evaluated using the statistical
package program IBM SPSS Statistics Standard Concurrent User V 25 (IBM Corp.,
Armonk, New York, USA).
Results: Of the 337 patients included in our study, 183 (54.3%) were female and 154
(45.7) were male and female / male ratio was 1: 1.2. The median age of the patients was
36 months (1 month-17.8 years). 175 (50.3%) of the patients with urolithiasis were
microlithiasis (stone size ≤ 3 mm). The most common reason for presentation was
incidental stones (41.8%). Pelvic-calyceal stones (54%) were the most common sites in
ultrasonography (USG). 129 (38.3%) patients had lower pole stones. Stone analysis was
performed in 16 patients and the most common calcium oxalate stone was detected.
While no metabolic risk factor (MRF) was detected in 24% of the cases, at least one
MRF was found in 76%. The most common MRF was hypocitraturia (32.9%) and the
second most common MRF was hyperoxaluria (29.9%) in all patients with USTH.
Hypercalcemia and hypouricemia in infants (<12 months); hyperuricemia,
hyperuricosuria, hypomagnesuria, hypocitraturia were more common in patients> 12
months. It was found that vitamin D abortion was more common in children> 12 
xi
months, in patients with upper-middle pole stone, in patients with single stone, and in
patients with stone size> 3 mm. Vitamin D elevation was more common in infants with
microlithiasis. Potassium citrate was the most common medical treatment for patients
with USTH. The improvement rates were higher in all patients with stone and in
patients with microlithiasis. In contrast to upper and middle pole stones, the rate of
improvement of lower pole stones with treatment was higher than the rate of notreatment.
When upper-middle pole stones and lower pole stones were compared, lower
pole stones showed less improvement.
Conclusion: In our study, at least one metabolic risk factor was found in the majority of
cases. Most of the patients with microlithiasis resolved spontaneously. Therefore, we
think that there is no need for treatment in this group of patients, but these patients
should be followed up because of the rare growth in stone size. Since the recovery rates
of lower pole stones are lower than upper-middle pole stones, medical treatment should
be started earlier. The improvement rate was higher in all stone groups without
treatment. The reason for this is treatment the majority of cases we did not give
microlithiasis, metabolic risk and upper and middle pole stones. In the light of all
findings, if stone size> 3mm, lower pole stone and metabolic risk factor are present,
medical treatment should be started.
Keywords; Urinary Stone Disease, Hypomagnesuria, Hypercalciuria, Metabolic
Disorder