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Objectives: To evaluate the pediatric patients with renal calculi in terms of bio-metabolic profile. Study Design: Cross sectional study. Place and Duration of Study: Department of pediatric nephrology the Children’s Hospital and the Institute of Child Health Lahore over a period of 10 months from Nov 2016 to Sep 2017. Material and Methods: A total 85 patients with urolithiasis up to the age of 14 years were enrolled for study. Structured history and tailored investigations were collected from all the patients. Results of the physical examination, blood chemistry, and urinary excretion of metabolites (urinary calcium, citrate, magnesium and oxalate) were recorded. Results: Out of 85 patients; 65% were males and 35% were females (2:1); mean age at presentation was 8.15 ± 5.04 years. Hypertension was documented in 57% patients. Mean level of urea and creatinine was 73.02 ± 59mg/dl and 4.435 ± 4.024mg/dl respectively. Vitamin D level was 37 ± 15.6ng/ml while serum PTH level was 51.2941 ± 26.067pg/l. Serum calcium and phosphorus was 8.54 ± 1.18 and 5.0224 ± 0.885 respectively. Among all patients, 95% were found to have metabolic abnormalities. The most common was hypercalciuria (54%) followed by hyperoxaluria in 28% patients. Hypocitraturia was seen in 21% patients. Distal renal tubular acidosis was found in 6% children. Only 5% children were having low magnesium level in their urine. Conclusion: Majority of the children with stone disease had underlying metabolic risk factor and in our setting, hypercalciuria is the most common one.

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