Urinary biomarker as a predictor of urolithiasis in children: a systematic review and meta-analysis.

INTRODUCTION

Urolithiasis in children has become a clinical concern because of its longterm impact on kidney function and quality of life. In previous studies, the role of urinary biomarkers in predicting the risk of urolithiasis in children was still unclear due to inconsistent findings. This meta-analysis aimed to evaluate the diagnostic potential of various urinary risk factors in children with urolithiasis.

METHODS

A systematic review and meta-analysis was performed based on PRISMA 2020 guidelines, registered in PROSPERO (CRD42025644893). A total of six studies (1 cohort and 5 case-control) involving 2,060 pediatric patients (817 with urolithiasis; 1,243 controls) were analyzed. Urinary risk factors - including citrate/creatinine (Cit/Cr), oxalate/creatinine (Ox/Cr), calcium/creatinine (Ca/Cr), phosphorus/creatinine (P/Cr), magnesium/ creatinine (Mg/Cr), and urea/creatinine (Ur/Cr) - were examined. Standard Mean Differences (SMD) were calculated, and heterogeneity was assessed using the I² statistic.

RESULTS

Significant differences were obtained in the Cit/Cr, Ca/Cr, Ox/Cr, and Mg/Cr ratios between children with urolithiasis and controls. Hypocitraturia (Cit/Cr SMD: -0.60, 95% CI: -0.90 to -0.30, p = 0.0001), hyperoxaluria (Ox/Cr SMD: 0.76, 95% CI: 0.37-1.16, p = 0.0001), hypercalciuria (Ca/Cr SMD: 0.55, 95% CI: 0.10-1.01, p = 0.02), and hypomagnesuria (SMD -0.13 (95% CI: -0.24 to -0.01), p = 0.03) were significantly associated with the formation of stones in the urinary tract. On the contrary, there were no significant relationships for P/Cr and Ur/Cr ratios.

CONCLUSIONS

This meta-analysis highlights Cit/Cr, Ox/Cr, and Ca/Cr ratios as potential urinary biomarkers to identify the risk of urolithiasis in pediatric patients. Hypocitraturia, hyperoxaluria, and hypercalciuria are the main metabolic abnormalities that contribute to urinary tract stone formation. Future studies with standardized methodology are essential to confirm these findings and guide clinical management strategies.