The Follow-up Study Of Melamine-related Infant Urinary Calculi

Objective: Since September 2008, Chinese media reported that several provinces and cities in the country found the infant urinary calculi. Confirmed by the relevant authorities for investigation, urinary calculi in children is mainly due to children consumed milk containing melamine. Melamine is an organic nitrogen-containing heterocyclic compounds, also known as cyanurotriamide, melamine, referred to as triamine, and commonly known as protein powder. Melamine is a low toxicity of chemical raw materials, and it mainly affecting the urinary system, and cause animal bladder inflammation, kidney inflammation, induced urinary tract stones and so on. by isolation and structure elucidation and quantitative determination of stone, the components of Melamine-induced urinary stone in the main group was divided into uric acid and melamine, both the ratio of approximately 2:1 (molar ratio). The average content of uric acid stones (53.9±11.7)%, melamine is (23.2±5.7)% [1]. Currently, the studies of melamine are mostly based on animal experiments, reported less based on human. This study through the follow-up analysis of the clinical outcomes of melamine-related infants urinary calculi in parts of Hebei Province, and understand the prognosis of urinary calculi, and improve the therapeutic and improve their prognosis, The same time, collection the relevant clinical data which may affect the efficacy to statistical, in order to further explore the melamine related to the pathogenesis of urinary tract stones lay the clinical foundation.Methods: The analysis was performed in patients with consumed melamine-contaminated milk powder who admitted in our hospital's pediatric between September 2008 to June 2009 about relevant indicators. All cases diagnosed with melamine-related infant urinary calculi according to the method of diagnosis and treatment on the consumption of contaminated Sanlu infant formula milk powder related toinfant urinary calculi by the Ministry of Health, General Office. Inclusion criteria:①The consumption of contaminated milk powder for infants whose age less than or equal 3-year-old (36 months).②Ultrasound diagnosis of stones, which to comply with the largest stone diameter greater than or equal 0.4cm. Exclusion criteria:①Urinary congenital lesion.②The disease of renal parenchymal. Choose age, gender, clinical symptoms, urine pH, hydronephrosis and position, diameter, number, complications of urinary calculi as the study of the factors. Efficacy criterion: the medical treatment of children with stones in the end be decided effect.①Cured group: urinary calculi and clinical symptoms are disappeared.②Uncured group: urinary calculi and clinical symptoms have not disappeared completely. All children from the date of diagnosis include observation of cases. Principles of treatment and medication are same (more than adequate water, oral sodium bicarbonate tablets to alkalization of urine), to remove the interference factor. Records of related data according to self-made forms and follow-up the efficacy of children. Follow-up period is 6 months. Follow-up and record the observation target of children in two weeks, 1 month, 3 month, 6-month after the diagnosis of urinary calculi, respectively. Statistical analysis: Measurements data to use the mean value±standard deviation. The statistical method between the two groups compares uses T-test, count data using chi-square test. The main data were tested for normality and homogeneity of variance test. P<0.05 has significance for difference. Carries on the statistical analysis using statistical analysis software SPSS16.0.Results:1 General information: All of the 127 cases were diagnosised by ultrasound in 2008. There were 77 boys and 50 girls in the 127 patients, the ratio of boy to girl is 1.34:1; Age from 3 months to 36 months, and the average age was 19.95±9.89 months. Right kidney stones (58 cases) more common, accounting for 45.66% of children with selected, followed by the left kidney 54 patients (42.52%), both of kidney stones 14 cases (11.02%), ureteral stone 1 case (0.79% ). The mean diameters of 127 calculi were 0.4~1.9cm, 73 cases were sand-type stones. Single stones more common, accounting for 70.87% of children with selected. Left hydronephrosis 17 cases (13.38%), right hydronephrosis 18 cases (14.17%), both hydronephrosis 11 cases (8.66%), the majority of children (81 cases) without hydronephrosis, accounting for all cases of gallstone of 63.78%. Leucocyturia 36 cases (28.34%), hematuria 29 cases (22.83%), proteinuria 15 cases (11.81%), the majority of children (47 cases) have no complications, no cases of kidney failure. In this study, there are 102 cases of children without any symptoms, oliguria 9 cases, dysuria (including voiding effort, Lek drops of urine was not a line-shaped) 16 cases, without fever and vomiting.2 The results show that: Treatment response has shown partial relationship with the number and diameter of urinary calculi and urine pH have statistically significant (P <0.05). Treatment response has no relationship with age, gender, hydronephrosis and position, complications of urinary calculi, non-statistically significant (P> 0.05).3 When half of month, there were 74 cases (58.3%) stones discharged, at 1 month, 98 cases (71.5%) stones discharged, at 3 months, 115 cases (83.9%) children with stones discharge, at 6 months, there were 117 cases (92.1%) children of the stones discharged, conservative medical treatment can fully discharged the majority of children with stones.Conclusion:1 After 6 months follow-up, most stones of the children are able to discharged. However, after 6 months of treatment, stone size remains unchanged in children whose stones are 12mm in diameter or more, and accompanied by hematuria and proteinuria, in which 4 cases by medical conservative treatment for 4 months did not improve, choose surgery.2 pH of seven cases in uncured group was significantly higher than cured group. We consider that the composition of stone may be more complex, not by uric acid as the main ingredient.We should be further testing the composition of stone to guide the treatment.3 Infants suffering from urinary tract stones in the kidney as the predilection sites, followed by ureteral stones, and no bladder stone. 4 The diameter of stone of uncured group is larger than cured group, and large diameter of stones more difficult to discharge, if necessary, surgical intervention should be done.5 Single stone discharge rate was higher than the rate of multiple stones discharged.6 Children in uncured group have hematuria, proteinuria or leucocyturia, there is left or right hydronephrosis. We should be further investigation and timely surgery in children with renal stone row. Once the stone obstruction active treatment as soon as possible, and should focus on were followed up urine, urinary tract ultrasound and renal function.7 Most of infant have no stone-related symptoms.