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Paediatric Surgery
Renal Calculus Disease
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
10 sections · 60 slides
Overview
- What this talk will teach you
The Basics
What a kidney stone is, and why children are different
- What is renal calculus disease?
- The headline numbers
- Why the number of paediatric stones is climbing
- Second reason: chronic-illness survival
Who Gets Stones
Epidemiology: sex, race, climate and geography
- Why children form fewer stones than adults
- Sex: the adult male pattern breaks down in children
- Race and geography shape stone risk
- Reported incidence varies widely by country
How Children Present
Clinical features and differential diagnosis
- Presenting symptoms depend heavily on age
- Sorting a stone from its mimics
Working It Up
Diagnostic evaluation and imaging
- The core principle: look for WHY the stone formed
- Initial evaluation of a child with urolithiasis
- Reading the urine pH – a free clue to stone type
- Normal urinary excretion of metabolites (timed)
- Imaging of the urinary tract for stones
- Imaging strategy: minimise radiation
Why Stones Form: Etiology
Metabolic, structural and infectious causes
- Three broad categories of cause
- Stone composition in children
- Hypercalciuria – too much calcium in the urine
- Hyperoxaluria – too much oxalate
- Hyperuricosuria – too much uric acid
- Cystinuria – an inherited transport defect
- Hypocitraturia – too little stone blocker
- Metabolic causes of paediatric urolithiasis – a summary
- Structural causes – urine that stagnates
- Infection – both a cause and a consequence
How Stones Actually Form
Pathogenesis and genetics
- Starting conditions: concentrated, low-volume urine
- Randall’s plaques and the vascular theory
- A growing genetic story
Managing the Acute Stone
Pain, obstruction and surgical options
- First priorities in an acute stone episode
- Will the stone pass by itself?
- Medical expulsive therapy (MET) – helping a stone pass
- Surgical options by stone size and situation
- Choosing a surgical approach – the practical rules
Preventing the Next Stone
Diet, drugs and surveillance
- Prevention starts with fluid and diet – for everyone
- Targeted preventive therapy by metabolic abnormality
- Why these particular drugs?
- Surveillance – catching recurrence early
Outcomes & The Future
Prognosis and open questions
- What happens over time
- Long-term outcomes
- Future directions – the open questions
- An 8-year-old passes a calcium oxalate stone. What does the work-up most often reveal, and what is first-line prevention?
- Key takeaways
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- Pediatric Surgery and Pediatric Urology