Recurrent Nephrolithiasis in Childhood Progressing to End-Stage Renal Disease: Case Report

Case Report

Austin J Nephrol Hypertens. 2015; 2(5): 1051.

Recurrent Nephrolithiasis in Childhood Progressing to End-Stage Renal Disease: Case Report

Marcos Frata Rihl*, Spada CM, De Souza VC, da Silva Selistre L

Department of Nephrology, University of Caxias do Sul, Brazil

*Corresponding author: Marcos Frata Rihl, Department of Nephrology, University of Caxias do Sul, Francisco Getúlio Vargas Street, 1130, Caxias do Sul, Brazil

Received: August 10, 2015; Accepted: November 15, 2015; Published: November 17, 2015


Introduction: The incidence of nephrolithiasis is uncommon in children. However, this disease must not be neglected, because it might lead to progressive loss of renal function and even the need of renal replacement therapy in this age group.

Case Report: Eighteen years-old female patient in renal replacement therapy had been followed since she was four years old because of recurrent urinary tract infections, without any anatomic alterations in the urinary tract. Appeared with a staghorn calculus in her left kidney at nine years old with progressive loss of glomerular filtration rate.

Discussion: Nephrolithiasis is pointed as a risk factor to chronic kidney disease, but rarely is identified as a cause of end stage renal disease. Patients with kidney stone that develop chronic kidney disease correspond from 0.8 to 17.5%, while 0.2 to 3.2% needs renal replacement therapy. The cause of renal insufficiency in patients with nephrolithiasis is multifactorial and includes renal obstruction, recurrent urinary tract infection, frequent surgical interventions and coexistent medical diseases.

Keywords: Nephrolithiasis; Chronic kidney disease; Renal replacement therapy


US: United States; CKD: Chronic Kidney Disease; ESRD: End- Stage Renal Disease; RRT: Renal Replacement Therapy; eGFR: estimated Glomerular Filtration Rate; DMSA: Dimercaptosuccinic Acid; USRDS: United States Renal Data System


The incidence of nephrolithiasis is uncommon in children [1]. In a population-based study from the United States (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 [2]. The hypothesis for the lower pediatric incidence 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 [3,4]. There are a growing number of publications that indicates an increased incidence of this disease in the pediatric population. However, 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 or even due to environmental factors [5-7].

In a case series of 221 children with nephrolithiasis from the Mayo Clinic, 148 (67%) had two or more stones during a mean follow-up of 59 months [8]. Schwarz and colleagues reported a recurrence rate of 30%. The incidence of recurrence increases if some metabolic abnormality that contributes to the formation of kidney stones is identified [9,10].

Nephrolithiasis is a condition that rarely leads to Chronic Kidney Disease (CKD) in childhood. Although very infrequent, this disease should not be overlooked because it may lead to progressive loss of renal function and, ultimately, End-Stage Renal Disease (ESRD) requiring Renal Replacement Therapy (RRT) [11-15].

Case Presentation

We describe the case of an 18-year-old white female patient undergoing RRT at our Nephrology Department, because of progressive ESRD due to nephrolithiasis.

She had been followed up at our Division of Pediatric Nephrology since she was 4 years old by recurrent urinary tract infections, where investigations were carried out with urinary tract ultrasound which showed normal anatomical aspect and voiding cystourethrogram that evidenced no vesicoureteral reflux. Her family history of renal disease was negative.

After a period of five years without nephrological follow-up, she returns with a staghorn calculus in the left kidney (Figure 1) and stones in the right kidney and stage II of CKD [16], with 75 ml/min/1.73 m² of estimated Glomerular Filtration Rate (eGFR) by Bedside Schwartz equation, with numerous episodes of nocturia. She underwent metabolic investigation, excluding hypercalciuria, hyperuricosuria, hyperphosphaturia and secondary hyperparathyroidism. She received prophylactic antibiotic therapy because of recurrent urinary tract infections and was followed up with urinary tract ultrasounds and abdominal X-rays. Dimercaptosuccinic Acid (DMSA) renal scintigraphy was performed which showed a moderate deficit of the left kidney function (Figure 2). The absolute renal function index was 15.8% for the left kidney and 34.2% for the right kidney (30%±3% normal range reference); relative renal function index was 31.5% for the left kidney and 64.5% for the right kidney.