Kidney Stones in Children
Over the last 20 years, kidney stones in kids and teenagers have increased in frequency. Although they can happen to kids of any age, including preterm newborns, the majority of stones affect teenagers.
When mineral and other components often found in urine come together to create a solid stone inside the urinary system, kidney stones can develop. They may also develop if the urine contains insufficient amounts of other elements that aid in preventing the formation of stones.
The ureter, or tube that links the kidneys to the bladder, and the kidney are where stones often develop. In the bladder, they hardly ever develop.
Kidney Stone Types
There are four primary categories of kidney stones:
The most typical kidney stone is a calcium stone.
Cystine seeps through the kidneys and into the urine as a result of a hereditary condition, which leads to cystine stones.
When there is an excess of uric acid in the urine, uric acid stones can develop. This form of stone may develop as a result of a diet high in animal proteins.
When a person has repeated urinary tract infections, struvite stones might develop.
What signs indicate kidney stones?
Kidney stones can occur in kids who show no symptoms. These stones are referred to as “silent stones” since they remain in the kidneys and have not gone to the ureter. Due to a urinary blockage, other youngsters may endure excruciating pain. Kidney stone symptoms frequently include:
- Blood in the pee and discomfort in the back, groin, or flank (side)
- Excessive urination
- Sickness vomiting
What Gives Rise to Kidney Stones?
Low urine output
Lack of fluid intake in children results in low urine volume. Urine turns black and concentrates as a result of this. Drinking more water will thin the urine and reduce the likelihood of stone development.
Diet high in sodium:
Calcium-based kidney stones are the most prevalent kind. The way salt in the diet is processed by your kidneys frequently results in calcium stones. When they consume a high salt diet, some people pass greater quantities of calcium in their urine. This can happen if you consume a lot of fast food and processed foods, or if you use excessive table salt. The greatest strategy to prevent calcium stone is to eat less salt.
Renal stone risk factors
- Kidney stones can develop as a result of several risk factors. Among the most typical ones are:
- Family history of stone formation
- A diet low in vegetables and fruits and heavy in meat, processed foods, and salt
- Low urine production due to inadequate fluid intake
Other danger signs consist of:
- certain inherited disorders (hyperoxaluria, cystinuria)
- Certain medications, such the blood pressure medication furosemide, which eliminates excess bodily water, or the seizure medication topiramate, for instance
- obstructed urination
- renal infection
How are kidney stones identified?
Making a precise and thorough diagnosis is the beginning step in caring for your kid. Using an ultrasonography or a CT scan to examine the urinary tract, our doctors can determine if your child does have a kidney stone. Our first diagnostic preference is ultrasound since it doesn’t subject your youngster to radiation.
We may perform a CT scan if the ultrasonography is unclear or if the doctor treating your kid has any concerns. The precise size and location of the stone can be found by your child’s doctor via a CT scan to aid with surgery planning.
A pediatric urologist and a pediatric nephrologist will examine your kid physically, talk with you about their health, evaluate any current prescription and any medications, and go over a full history of your child’s food and fluid consumption during your consultation.
In order to send a stone for chemical analysis, you must try to retrieve it after your child gets a stone, put it in a plastic wrapper, and bring it with you to your appointment. During the appointment, we will also conduct a number of tests, including:
- Urine examination to determine potential stone-forming variables, such as higher calcium levels in the urine
- Blood testing to identify additional risk factors
- If the stone has been removed or passed, a chemical analysis will be performed to identify the kind of stone and offer crucial hints about how it developed.
- Review of risk factors for hereditary illnesses
How can I help my child avoid kidney stones?
The cause of the stones’ formation is a key factor in effective prevention. To determine health risks for stone development, your child’s doctors will do a metabolic examination. Following this metabolic analysis, your doctor will have a better idea of what is producing the stones and how to keep your kid from getting any more. To assist prevent kidney stones from recurring, medicines may occasionally be needed. Also helpful are the hints listed below:
Encourage your kid to sip on water frequently throughout the day, not just when they are thirsty. Drinking enough water is crucial. Checking the color of your child’s urine is a great method to see if they are getting enough water; if it is clear, they are. They are dehydrated if their urine is yellow.
Examine the label before consuming any sports drinks to see whether salt has been added, and stay away from anything with a lot of sodium. The greatest approach to keep hydrated and lower your child’s risk of acquiring stones is to drink plenty of water. In general, urine should include citrate.
Avoid high-fat and salty foods such packaged meats, canned soups, premade meals, and chips and French fries. Keep the saltshaker off of the dining table and avoid salting food as it is being prepared to reduce your consumption of salt. A nutritious diet that emphasizes fruits and vegetables should be provided, and the RDAs for proteins, magnesium, and vitamin D should also be provided.
Workout, workout, workout. Although healthy kids can get kidney stones, several experts think the incidence rates may be increased due to obesity. Make sure your kid drinks water while they exercise. Take additional care with nutrition, exercise, and water intake if kidney stones run in the family.
Reduce the amount of calcium in your child’s diet ONLY if your doctor advises it. Many people believe that since stones are formed of calcium, cutting back on calcium in their diet will help to decrease stone development. However, because calcium is a vital vitamin (particularly for youngsters) and the body processes calcium in a very intricate way, limiting calcium intake is not the only way to prevent the development of calcium kidney stones. In general, we advise patients to consume the recommended daily allowances of calcium and vitamin D.
What is the treatment for kidney stones?
Treatment regimens are determined by the underlying cause of the stones, but to lower the risk of kidney stone recurrence, your child’s doctor may advise a high fluid intake as well as a low-salt diet.
The nephrologist may recommend drugs to assist prevent stones from developing, such as drugs that reduce calcium levels in urine or other drugs that aid in the dissolution of chemicals in urine.
Doctors will develop an individual care plan depending on the type and characteristics of the issue if your kid has a hereditary condition that causes kidney stones.
The risk of kidney stones may be increased by a number of disorders, including primary hyperuricemia, Dent illness, and cystinuria.
The size, location, quantity, and nature of your children’s stone will determine the best course of action.
Stones can frequently pass on their own without the need for any kind of therapy; in fact, kids could pass stones that really are considerably larger than those that grownups can pass.
One or more drugs that have been demonstrated to boost the likelihood that a stone may pass spontaneously may be prescribed by your child’s doctor.
In some cases, based on your child’s symptoms and health, the stones must be removed.
In addition, rather than wait until a stone is quite large, we can think about removing it now, even if it is not causing any symptoms. The strategy you use will depend on the anatomy of your child as well as the position, size, and kind of stone. The following are some techniques:
Shock wave lithotripsy outside the body
Stones are most frequently treated with extracorporeal shock lithotripsy (ESWL), which is also the least intrusive method. A lithotripter is a specialized device used by ESWL to deliver shock waves through into the body and into the body of a child.
Similar to how a magnifying lens may concentrate sunlight to produce extreme heat, the lithotripter directs the shock waves to the exact spot in which the stone is situated. The stone shatters into tiny pieces as a result.
It might take up to one hour for the lithotripter to progressively apply thousands of shock waves. Over the next few days, the particles will eventually pass in the urine.
Your child’s skin and internal organs are not harmed by the shock waves since they are not focussed when they penetrate the skin.
Although there may be some discomfort associated with this technique, it is crucial that your kid stay calm for the whole time in order for the shock waves to be precisely focused. We do this surgery under general anesthesia because of this.
Depending on where the stone is located, it might take up to 3 months for all of the pieces to pass after therapy.
ESWL has an average success rate of roughly 85%. Decreased pole kidney stones have a lower likelihood of passing.
Some types of calcium stones and other extremely hard stones, including those formed of cystine, may not break very effectively.
This procedure involves inserting a tiny scope through the urethral into your kid’s bladder and then up to one or both of the ureters and kidneys.
The ureters are the tubes that link the kidneys with the bladder. Doctors can see the stones with the help of digital cameras that are attached to a scope and extract them with a range of tools that have been particularly made.
Anesthesia is used during ureteroscopy. The rate of success is really high—in the range of 95%.
Success rates are less in kids whose urinary architecture makes it challenging to bring the reflector to the stone and for big stones, which may necessitate several procedures.
Percutaneous kidney stone removal
Large kidney stones are treated by percutaneous nephrolithotomy (PCNL). Under the supervision of an ultrasound or x-ray, a needle is inserted through your child’s skin and then into their kidney.
The stone is then directly examined, broken up, and removed using a device that is inserted into the kidney.
Under general anesthesia, PCNL is performed. Typically, a kidney drainage tube is left in for between two and four days.
If your kid has an atypical kidney architecture or a hard or huge stone that would not fracture with ESWL, PCNL is very helpful. Small children can have entry to the kidney for kidney stone removal thanks to a specific, small-access sheath.
Open stone Surgery
In the past, practically all stones needed to be removed by open surgery. The majority of stones may now be removed with a less intrusive method thanks to technological advancements. In rare cases, infants with atypical anatomy or other special issues still require open stone surgery.