Childhood urolithiasis is an evolving condition with an increasing incidence and 
prevalence over the last 2 decades. Over that time the underlying cause has 
shifted from predominantly infectious to metabolic in nature. This review 
describes the pathophysiology, underlying metabolic abnormalities, clinical 
presentation, evaluation, and management of childhood urolithiasis. A 
comprehensive metabolic evaluation is essential for all children with renal 
calculi, given the high rate of recurrence and the importance of excluding 
inherited progressive conditions.