Stone formations multiple places and recurrent

This 4 years female child had surgery for 23mm bladder stone at 18 months age.  Stone analysis was suggestive of mainly Xanthine stone 

Before six month she underwent PCNL for right renal stones. 
Those were mainly calcium oxalate monohydrate stones. 
Now six months later  she has recurrence of stone on right side. 
What can be the underline issues? 
For what and how she should be evaluated to get upto the underlying issues? 

Stone formations multiple places and recurrent Stone formations multiple places and recurrent Stone formations multiple places and recurrent Stone formations multiple places and recurrent Stone formations multiple places and recurrent Stone formations multiple places and recurrent View Document


  • Ashish parikh
    Ashish parikh
    10 Mar 2020 07:11:44 PM

    Respected sir,

    calcium oxalate monohydrate(whewellite) and uric acid (uricite) both are non infective stone.
    so mainly metabolic problem is there.
    low urine PH and enteric hyperoxaluria are two possibility for recurrence in such type of stone.
    serum uric acid level, 24 hr urinary uric acid level and urine PH required specifically in this case.
    so she needs potassium citrate for prevention of recurrence.
    i attached one file for systemic evaluation of such stones.
    Thanks and Regards

    View Document

  • Dr. Anil Takvani
    Dr. Anil Takvani
    11 Mar 2020 07:57:11 AM

    Dear Aashish, 

    Thank you very much. 
    What about bladder stone analysis :
    mainly Xanthine stone? 
    Can you and other expert members elaborate on possible investigations? 

  • shriram joshi
    shriram joshi
    11 Mar 2020 08:19:16 PM

    This child seems to have uricosuria and calcium monohydrate deposition on this nucleus of uric acid crystals. One also has to exclude renal tubular acidosis. 

    I would therefore, recommend :
    1. Creatinine, electrolytes including bicarb, serum uric acid, serum magnesium, calcium, urine culture and sensitivity
    2. urinary spot protein/creatinine ratio for prognosis of renal damage, in view of recurrent stone formation.
    3. 24 hours urinary calcium, uric acid, phosphorus, citric acid, oxalate, pH of urine
    Parathyroid disease is uncommon in children with normal renal function. Secondary hyperparathyroidism can occur in renal failure. 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    12 Mar 2020 08:09:00 AM

    Thank you very much Sir.

    Will get all these tests done and will post the findings...
    Any more expert comments? How often you get paediatric cases with recurrent or multiple site urinary tract stones? Do you advice for metabolic assessment?

  • shriram joshi
    shriram joshi
    12 Mar 2020 07:48:17 PM

    Dear Anil,

    Bladder or solitary kidney stone I don't do such detail metabolic work up. Mainly because it is very difficult to get a good 24 hours collection in children. Great ormond street childrens' hospital, London did a trial in children who were admitted for tonsillectomy. A child who is confined to bed most of the time, will give a higher result. 
    Ideally we should be doing metabolic work up in every case except the bladder stones. But certainly in the case presented needs full work up. Multiple site stones or bilateral stones I don't see often, maybe because Mumbai is not in the stone belt. We should ask Ravindra Sabnis to comment on this after he is finished with the Goa Conference.

  • Dr. Anil Takvani
    Dr. Anil Takvani
    13 Mar 2020 07:36:53 AM

    Agree Sir. 

    We have to put child on catheter for 24 hrs urine analysis since the child passing urine without informing parents.
    Mother is government health worker and very much in panic.

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