Infants and children with urinary stones 1. What clinical symptoms may occur after infants and children consume problematic milk powder that causes urinary stones? A: Clinical symptoms include: (a) unexplained crying, especially when urinating, may be accompanied by vomiting; (b) visual or microscopic hematuria; (c) acute obstructive renal failure, manifested as oliguria or anuria; (d) stones can be discharged in the urine, such as male infants stone obstruction of the urethra can be manifested as painful urination, difficult urination; Yang Bo, Department of Pediatrics, Changsha Fourth Hospital (e) may have hypertension, edema, percussion pain in the kidney area. 2. How to diagnose that the urinary stones are caused by consuming the problem milk powder? A: It can be determined from the following aspects: (1) History of problematic milk powder feeding. (2) One or more of the above clinical manifestations. (3) Laboratory tests: routine urine (visual or microscopic hematuria), blood biochemistry, liver and kidney function, urinary calcium/urinary creatinine (generally normal), urinary red blood cell morphology (non-glomerular-derived hematuria), parathyroid hormone measurement (generally normal). (4) Imaging: Urological ultrasound is preferred. If necessary, CT scan of the abdomen and intravenous urography (contraindicated in anuria or renal failure), and renal nuclear scan to evaluate renal function when available. 3. Under what circumstances should infants and children who consume problematic milk powder go to the hospital? A: Infants and children who have consumed problematic milk powder for a period of time, usually 3-6 months, especially when symptoms such as unexplained crying, vomiting, fever, cloudy urine, hematuria, oliguria or anuria occur, should immediately go to the nearest medical institution for screening and consultation. Only when these symptoms occur should you seek immediate screening at a hospital. Since infants and children with pain may sometimes reflect unlike adults, they may just show restlessness and crying, I hope that as parents should pay attention to these reactions of their children and not ignore these phenomena, some serious cases are because parents do not notice and do not seek medical attention in time, as a result, they have this pain symptom for a long time, sometimes urine is reduced or even no urine, parents do not go to the hospital in time, making the consequences This makes the consequences more serious. What ultrasound examination should be done for children who have consumed problematic milk powder? A: Ultrasound of the urinary tract is preferred. If necessary, CT scan of the abdomen and intravenous urography (contraindicated in anuria or renal failure) should be performed, and renal nuclear scan should be performed to evaluate renal function. 5. What are the characteristics of ultrasound examination of urinary stones in infants and children caused by consumption of problematic milk powder? A: General features: both kidneys are enlarged; parenchymal echogenicity is enhanced and the parenchyma is mostly of normal thickness; the renal pelvis and calyces are mildly dilated and the calyces are rounded; if the obstruction is located in the ureteral lumen, the ureter is dilated above the point of obstruction; in some cases, the perinephric fat pad and the soft tissue around the ureter are edematous; as the disease progresses, secondary edematous thickening of the renal pelvis wall and ureteral wall may occur; in a few patients, a small amount of ascites may be detected. Features of stones: most of the stones involve bilateral collecting system and bilateral ureters; ureteral stones are mostly located at the pelvic-ureteral junction, ureteral cross-iliac artery segment and ureteral-vesical junction; stones are crumb-like accumulation, involving a large area, with a faint posterior shadow, most of them are different from calcium oxalate stones, and the posterior edge of stones can be detected; urinary tract obstruction due to stones is more complete. 6. Is there a latent period for urinary stones? A: The vast majority of the children are less than one year old and have been taking Sanlu infant formula for several months, and the time when the formula became problematic has not yet been defined, so the incubation period is unknown. 7. What should I do if my child is consuming Sanlu milk powder? A: If you are eating Sanlu milk powder, it is recommended to immediately stop eating, pay attention to observation, drink more water, such as children appear urinary system discomfort and other symptoms, should promptly go to the hospital for examination. 8. What kind of stones can be formed in the human body by melamine in the milk powder in question? A: Melamine and the salts formed in the body are slightly soluble in water and are excreted in the body mainly through the kidneys. During excretion, because it is slightly soluble in water, it easily precipitates in the urethra and kidney tubules, resulting in stones, which are loose in physical characteristics and can be crushed with a pinch. 9. Why do infants and toddlers who are fed with problematic milk powder need to drink more water? A: Parents should be on high alert for infants and children who have indeed been fed with problematic milk powder. First, stop using this brand of milk powder. Secondly, the stones caused by the contaminated formula are loose or fine sand-like. For children who do not have large stones (less than 4mm) and do not have symptoms of urethral obstruction, special treatment is generally not necessary and they should drink more water and urinate more often after going home. 10. Will the stones be in the vas deferens after the child has eaten melamine-containing milk powder? A: Melamine is excreted in the body mainly through the kidneys, and the target organ of toxicity in the body is the urinary system. The health hazards of melamine-contaminated infant formula found in this case are also stones in the urinary system after consumption by infants. The so-called urinary system mainly refers to the ureter, bladder, urethra and not the vas deferens. The vas deferens does not belong to the urinary system, but to the reproductive system. Therefore, the stones caused by melamine may only be in the urinary system, not inside the vas deferens of the reproductive system. 11. Will there be sequelae for children who develop kidney stones? A: Asymptomatic or less symptomatic infants and children have a better prognosis, because the stones are characterized by loose or mud-like. For children who develop kidney stones, in principle, surgical treatment is not recommended, but rather conservative medical treatment, and children with stones with a diameter of 3 years old stones should be carefully identified, congenital malformations, metabolic diseases, etc. 3. CT, MRI is not used as a mandatory screening test, to master the indications. 4. Conservative treatment, just pay attention to appropriate water intake. 5. Alkalinization of urine, oral soda is not recommended, hospitalized children can be given 5% baking soda 2-3ml/kg (to be diluted into 1.4% isotonic solution intravenous drip) for 2-3 days, urine PH value can be maintained between 6.5-7.