1 3 Urolithiasis DOI 10.1007/s00240-016-0922-5 ORIGINAL PAPER Metabolic risk factors in pediatric stone formers: a report from an emerging economy Kiran Imran 1 · Mirza Naqi Zafar 1 · Uzma Ozair 1 · Sadia Khan 1 · Syed Adibul Hasan Rizvi 1 Received: 27 June 2016 / Accepted: 12 September 2016 © Springer-Verlag Berlin Heidelberg 2016 appropriate metaphylaxis can be undertaken both for treat- ment and prevention of recurrence. Keywords Pediatric · Urolithiasis · Metabolic · Risk factors Introduction The incidence and prevalence of urolithiasis depends on multiple factors such as geographical location, climatic con- ditions, age, race, sex, diet, stone location, and its chemi- cal and physical composition [1]. Pediatric urolithiasis is a significant health problem in low resource settings [2]. The estimated prevalence rate of about 15 % is much higher than 1–5 % reported from developed countries [3, 4]. The major causes of urolithiasis in low resource settings are idiopathic in 55 %, metabolic abnormalities in 25 %, anatomical abnor- malities in 12 % and infection in 7 % [4]. The disease is endemic in Pakistan affecting children of ages below 1 year to adolescence with male predominance. The peak age for renal stones is 6–10 years and that for bladder 1–5 years [4]. Bladder calculi constitute up to 20 % of the stones in children as compared to <1–3 % in developed countries [5]. Many children with stones present with renal failure due to neglect and delay in seeking medical advice [6]. Evaluation of risk factors is important in the treatment and prevention of urolithiasis, especially in pediatric pop- ulation [5]. A study on metabolic risk factors in children identified a single risk factor in 52.2 % of patients and mul- tiple risk factors in 31 % [7]. A previous study from our institute on children who were treated for stone disease showed several urinary risk factors including hyperuricosu- ria in 27 %, hyperoxaluria in 40 % and hypocitraturia in 63 % [4]. Abstract The goal of this study was to investigate meta- bolic risk factors in pediatric stone formers in an emerg- ing economy. A prospective, data collection enrolled 250 children age <1–15 years at our center. Risk factors were evaluated by gender and in age groups <1–5, 6–10 and 11–15 years. Patients were evaluated for demograph- ics, blood and 24 h urine for calcium, magnesium, phos- phate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infec- tion in 18 (7 %) and chronic diarrhea in 75 (30 %). Hyper- calcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary met- abolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyper- oxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk fac- tors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1–5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11–15 years (p < 0.001), respec- tively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where * Kiran Imran kiranimran10@gmail.com 1 Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan