Evaluation of signs and symptoms in different age groups.
- Neonates, low birth weight, and premature infants present with haematuria and oliguria treated by loop diuretic (leading to hypercalciuria).
- Infants and young children identified with stones during assessment for haematuria, pyuria, UTI, or vague abdominal pain.
- Older children present with classic renal colic, gross or microscopic haematuria, and UTI.
- Adolescents and many older kids presenting with ureteric colic are more likely to have ureteral stones and many have associated nausea, vomiting, or azotaemia.
Initial laboratory assessment
- Urinalysis and urine culture to look for UTI.
- Uninary pH – may indicate type of stone.
- Spot urine calcium/creatinine ratio to access severity of hypercalciuria.
- 24-hr urine study for calcium, oxalate, phosphate, uric acid, and creatinine levels.
- Serum electrolytes including calcium, phosphorus, uric acid,serum urea, and creatinine, parathyroid hormone levels for kids with suspected hyper-parathyroidism.
In contrast to adults, metabolic work up is recommended in all children during the initial presentation of stones.
Radiological assessment
- Ultrasound is recommended as the first line of imaging. Stones are noticed as hyperechoic shadows.
- Plain X-ray KUB has a low sensitivity and specificity and is mainly used for monitoring the size and location.
- Non-contrast CT has a high sensitivity (96-100%) regardless of the location.