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Epidemiology of and risk factors for nephrolithiasis in children

Authors
Jodi Smith, MD, MPH
F Bruder Stapleton, MD
Section Editor
Laurence S Baskin, MD, FAAP
Deputy Editor
Melanie S Kim, MD

INTRODUCTION

Nephrolithiasis is increasingly recognized in children. The epidemiology and etiology of nephrolithiasis in children will be reviewed here. The clinical manifestations, diagnosis, acute management, and prevention of recurrence are discussed separately. (See "Clinical features and diagnosis of nephrolithiasis in children" and "Acute management of nephrolithiasis in children" and "Prevention of recurrent nephrolithiasis in children".)

EPIDEMIOLOGY

The diagnosis of pediatric nephrolithiasis has increased over the past 25 years. This was illustrated in a population-based study of children who were younger than 18 years of age from a single county in Minnesota that reported a yearly increase in the incidence of nephrolithiasis over a 25-year period from 1984 to 2008 [1]. The age-gender adjusted pediatric nephrolithiasis rate rose from 7.2 to 14.5 per 100,000 person-years between the two time periods of 1984 to 1990 and 2003 to 2008. In this study, it remains uncertain whether there was a true increase in the risk of pediatric nephrolithiasis or if there was improvement in making the diagnosis of stone disease with the use of computerized tomography.

In a study analyzing Pediatric Health Information System (PHIS) data from 41 freestanding United States (US) pediatric hospitals from 2002 to 2007, the diagnosis of nephrolithiasis was made in one case for every 685 pediatric hospitalizations [2].

Another report based on the PHIS data demonstrated that the proportion of hospitalizations due to pediatric nephrolithiasis rose from 18.4 per 100,000 admissions in 1999 to 57 per 100,000 in 2008 [3]. This trend is similar to the increased incidence in adult nephrolithiasis, which is thought to be due to changes in dietary habits (eg, increased intake of animal protein and sodium) and increased prevalence of obesity.

Age — The incidence of nephrolithiasis is lower in children than in adults. As an example, in a population-based study from the US of patients over 10 years of age, adolescents between 10 and 19 years of age accounted for only 4 percent of the total episodes of nephrolithiasis [4]. For the total population, the incidence of nephrolithiasis was 109 per 100,000 men per year and 36 per 100,000 women per year. The explanation for the lower pediatric incidence is unknown, but may be due in part to the higher concentrations of crystal formation inhibitors such as citrate and magnesium in the urine of children compared with adults [5,6].

                    

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