RISK FACTORS FOR RECURRENT PEDIATRIC UROLITHIASIS STUDY AT JINNAH MEDICAL COLLEGE AND JINNAH TEACHING HOSPITAL

Abstract

Background: There is growing evidence that pediatric urolithiasis is a relapsing and remitting condition that can be affected by several metabolic, dietary, infectious, anatomical, familial and treatment factors. Children are at risk of frequent pain, urinary tract infection, urinary tract obstruction, repeated procedures, and progressive renal damage with recurrent stone formations. Therefore, it is crucial to identify the recurrence predictors at an early stage in order to plan preventative treatment and long term follow-up.
Objective: To determine the frequency of recurrent pediatric urolithiasis and identify the clinical, dietary, metabolic, radiological, and treatment-related factors associated with recurrence among children treated at Jinnah Teaching Hospital, Peshawar.
Methodology: This prospective observational cohort study was carried out in Jinnah Teaching Hospital, Peshawar from June 2024 to January 2026. The patients consisted of 91 children, consecutively sampled and with a confirmed diagnosis of urolithiasis using radiology. Demographic data, family history, diet/hydration habits, clinical presentation, UTI history, stone characteristics, anatomical abnormalities, metabolic findings, treatment history, and compliance with prevention measures were recorded. The participants were divided into two groups; recurrent and non-recurrent. Appropriate statistical analysis was used to make group comparisons and multivariable binary logistic regression was used to determine independent predictors of recurrence. The p-value was set at < 0.05.
Results: The mean age of the participants was 9.36 ± 3.82 years, and 55 (60.4%) were male. Recurrent urolithiasis was identified in 32 children, giving a recurrence rate of 35.2%. Positive family history, parental consanguinity, recurrent urinary tract infection, inadequate fluid intake, high salt intake, multiple and bilateral stones, larger stone size, hydronephrosis, nephrocalcinosis, residual stone fragments, hypercalciuria, hypocitraturia, low urine volume, and poor adherence to preventive recommendations were significantly associated with recurrence. On multivariable analysis, positive family history, inadequate fluid intake, recurrent urinary tract infection, multiple stones, residual fragments, hypercalciuria, and poor preventive adherence remained independent predictors. Residual stone fragments showed the strongest association with recurrence.
Conclusion: Recurrent pediatric urolithiasis affected more than one-third of the study population. Familial predisposition, inadequate hydration, urinary infection, increased stone burden, residual fragments, metabolic abnormalities, and poor preventive adherence contributed substantially to recurrence. Comprehensive metabolic evaluation, complete stone clearance, dietary modification, adequate fluid intake, infection control, and structured follow-up are essential for reducing recurrent stone formation in children.