Why we need a higher suspicion index of urolithiasis in children.
BACKGROUND
Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms.


STUDY DESIGN
We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures.


CONCLUSIONS
It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.
['Marzuillo|Pierluigi|P|', 'Guarino|Stefano|S|', 'Apicella|Andrea|A|', 'La Manna|Angela|A|', 'Polito|Cesare|C|']
D015746:Abdominal Pain D002648:Child D002675:Child, Preschool D018450:Disease Progression D053159:Dysuria D005260:Female D005500:Follow-Up Studies D006417:Hematuria D006801:Humans D008297:Male D008991:Monitoring, Physiologic D012008:Recurrence D018570:Risk Assessment D012720:Severity of Illness Index D013997:Time Factors D018608:Ultrasonography, Doppler D014567:Urography D052878:Urolithiasis
Children Occult urolithiasis Abdominal pain Overt urolithiasis