Lithiase urinaire de l’enfant

Abstract

Urolithiasis is not uncommon in children and must be looked for with ultrasonography in any case of pyuria, hematuria or abdominal pain. By means of precise analysis of stone composition or, failing stone, of urines, an etiology can be found in approximately 80 % of child lithiases. In younger children, the two main causes are infection due to urease-producing bacteria, associated or not with urinary tract malformations, and metabolic disorders induced by prematurity and treatment of its complications (furosemide, steroids). In older children, metabolic disorders, particularly those due to inherited diseases, account for the majority of stones : hypercalciurias, secondary, iatrogenic or idiopathic, hyperoxalurias, primary (inherited), secondary, or “mild idiopathic”, cystinuria, hyperuricosurias, inherited or secondary, and other purine excretion disorders. Prevention of stone recurrence, essential in case of underlying metabolic disorder, always requires an abundant water intake (1.5-2 l/m²/day) associated with specific treatment of the causal disease if possible. If a surgical treatment is necessary, extra corporeal shock-wave lithotripsy is the first option like in adults.