8.2 Diagnosis
Children are considered to be high-risk patients and need a full metabolic work up. The patient's history is particularly important as many metabolic disorders are hereditary [e.g. autosomal recessive disorders (cystinuria, primary hyperoxaluria, 2,8-dihydroxyadenine and xanthine calculi); autosomal dominant disorders (renal tubular acidosis, idiopathic hypercalciuria)]. In cases of a positive family history, an unfavourable clinical course has to be reckoned with.
In children, hypercalciuria with hypercalcaemia is frequently caused by immobilization (e.g. during fracture treatment). Another rare condition is hyperparathyroidism. As stone formation only occurs in a subset of immobilized children, a complete metabolic work up should be performed, as other metabolic disorders may facilitate the manifestation.
It must also be emphasized that the normal values of the excretion rate of lithogenous and inhibitory agents in adults cannot be applied to children, but requires correction for body weight (mmol/kg/d) as below. Variation between laboratories must also be considered.
Table 12: Critical values for renal excretion in children: when to start therapy
| mmol/kg*d-1 |
Calcium | >0.1 |
Oxalate | > 0.0063 |
Uric acid | > 0.063 |
Citrate* | < 0.01 |
Cystine | heterocygotous 0.0058-0.0117 |
| homocygotous > 0.024 |
Magnesium | < 0.045 |
Phosphate | > 0.483 |
Tlease note the presence of citrate splitting bacteria in the urine sample
- 1. Phimosis
- 1.1 Background
- 1.2 Diagnosis
- 1.3 Treatment
- 1.4 References
- 2.2 Diagnosis
- 2.3 Treatment
- V Therapy
- 3.3 Treatment
- 3.3.1 Complications
- Tube-onlay
- 15. Duckett jw.
- 4.2 Classification
- 4.2.1 Enuresis
- 4.2.2 Urinary incontinence
- 4.3 Diagnosis
- 4.4 Treatment
- 4.4.1 Nocturnal enuresis (mono-symptomatic)
- 4.4.2 Diurnal enuresis (in children with attention disorders)
- 4.4.3 Urinary incontinence
- 4.4 References
- 14. Madersbacher h, Schultz-Lampel d.
- 5.2.2 Voiding cystourethrography (vcug)
- 5.2.3 Diuresis renography
- 5.2.4 Static renal scintigraphy
- 5.2.5 Intravenous urogram (ivu)
- 5.2.6 Whitaker's test
- 5.3 Treatment
- 5.3.2 Megaureter
- 5.3.3 Ureterocele
- 5.3.4 Retrocaval ureter
- 5.3.5 Bilateral hydronephrosis
- 5.4 References
- 6.3 Treatment
- 6.3.1 Asymptomatic bacteriuria
- 6.3.2 Acute uti without pyelonephritis
- 6.3.3 Pyelonephritis
- 6.3.4 Complicated uti
- 6.3.5 Antibiotic prophylaxis
- 6.4 References
- 7.7.1 Secondary reflux
- 7.2 Classification
- 7.3 Diagnosis
- 7.3.1 Secondary reflux
- 7.4 Treatment
- 7.4.1 Conservative therapy
- 7.4.2 Surgical therapy
- 7.4.3 Endoscopic therapy
- 7.4.4 Open surgery
- 7.4.5 Follow-up
- 7.5 References
- 32. McGladdery sl, Aparicio s, Verrier Jones k, Roberts r, Sacks sh.
- 8.2 Diagnosis
- 8.3 Treatment
- 8.3.1 Conservative treatment
- 8.3.2 Metaphylaxis of paediatric nephrolithiasis
- 8.4 References
- 1. Brandle e, Hautmann r.
- 2. Brandle e, Hautmann r.
- 6. Diamond da, Rickwood am, Lee ph, Johnston jh.
- 19. Kovacevic l, Kovacevic s, Smoljanic z, Peco-Antic a, Kostic n, Gajic m, Kovacevic n, Jovanovic o.
- 20. Kroovand rl.
- 24. Minevich e, Rousseau mb, Wacksman j, Lewis ag, Sheldon ca.
- 9.2 Classification
- 9.2.1 Ectopic ureterocele
- 9.2.2 Orthotopic ureterocele
- 9.2.3 Caecoureterocele
- 9.3 Diagnosis
- 9.3.1 Ureterocele
- 9.3.2 Ectopic ureter
- 9.4 Treatment
- 9.4.1 Ureterocele
- 9.4.2 Ectopic ureter
- 10.2 Classification
- VI. Miscellaneous (? Dysgenetic testes ? teratogenic factors)
- 10.3.2 Late diagnosis and management
- 10.4 Treatment
- 10.4.1 Genitoplasty
- 10.4.2 Indications for the removal of gonads
- 10.5 References
- 11.1.4 Video-urodynamic evaluation
- 11.1.5 Urethral pressure profile (sphincterometry)
- 11.1.6 Electromyography (emg) of the external sphincter
- 11.2 References
- 22. Starr nt.
- 23. Wan j, Greenfield s.
- 26. Zermann dh, Lindner h, Huschke t, Schubert j.
- 12 Abbreviations used in the text