(Renal Colic—Child; Renal Lithiasis—Child; Nephrolithiasis—Child; Renal Calculi—Child)
Definition
Definition
Kidney stones are crystallized material in the urine. These stones form in the kidneys or other parts of the urinary tract. Kidney stones may be made up of a variety of minerals in the blood. The most common are calcium, oxalate or phosphate. Others stones may contain uric acid, struvite, and/or cystine.
Kidney StoneCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
Some of the known causes of kidney stones in children include:
- Too much oxalate in the urine
- Too much calcium in the urine or blood
- Too much uric acid in the urine
- Tiny bacteria a stone can form around
- Inherited abnormality in the way the body handles cystine
- Foreign bodies in the urinary tract, like stents or catheters
- Abnormal function of the urinary tract, such as neurogenic bladder
Risk Factors
Risk Factors
Factors that may increase your child’s chance of developing kidney stones include:
- Dehydration —not drinking enough fluids
- Eating foods high in salt
- Eating a ketogenic diet to help control epilepsy
- Mineral content of water your child drinks (hardness or softness of the water)
- Having family members who have had kidney stones or gout
- Having kidney stones in the past
- Being overweight
- Medical conditions, such as urinary tract infections or metabolic conditions
- Geographic location—residents of the Southeast United States have an increased risk
- Limited physical activity
- Foreign material in the urinary tract, such as a catheter
Symptoms
Symptoms
Occasionally, kidney stones do not cause symptoms, and they leave the body in the urine. Often a kidney stone can cause severe pain and symptoms such as:
- Sudden, severe pain in the side of the body or mid- or lower back when it moves
- Pain in the belly or groin area
- Nausea or vomiting
- Blood in the urine
- Burning pain when urinating
- Fever
- Recurring urinary tract infections
Diagnosis
Diagnosis
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done.
Images of the kidneys and urinary tract may be taken with:
- Ultrasound
- KUB (kidney, ureter, bladder) x-rays
- Spiral CT scan
- Rarely, Intravenous pyelogram (IVP)
A 24-hour urine test may also be done to look for levels of minerals in the urine including calcium, phosphorus, uric acid, oxalate, and citrate.
Treatment
Treatment
Treatment depends on the size and location of the kidney stone. Treatment may include:
Water
For small kidney stones, having your child drink plenty of water will help their body pass the stone in the urine. The doctor may provide a special cup to catch the stone when it passes so that it can be analyzed. If your child is having a hard time keeping fluids down, they may need to be hospitalized to receive fluids in their vein. The doctor may also give your child medications to control pain and antibiotics until the stone passes.
Medication
Your child may be advised to take:
- Over-the-counter pain relivers
- Prescription pain relievers
- Medication to dissolve the kidney stone
Surgery
Surgery may be needed if the stone is:
- Very large or growing larger
- Causing bleeding or damage to the kidney
- Causing infection
- Blocking the flow of urine
- Unable to pass on its own
Types of surgery include:
- Extracorporeal shock wave lithotripsy (ESWL)—uses shock waves to break up stones that are too large to pass
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Ureteroscopy and stone basketing or laser lithotripsy—camera is used to locate the stone
- Stone basketing—A tiny basket is used to remove the stone.
- Laser lithotripsy—The stone is broken into smaller pieces with a laser if it is too large to remove.
- Percutaneous nephrolithotomy—uses a scope placed through a small tube in the back to remove a large stone (rare)
- Lithotomy—open surgery to remove a stone (rare)
Prevention
Prevention
Your child is likely to have another kidney stone if they had one before. To help reduce your child’s chance of future stones:
- Have your child drink plenty of fluids, especially water. Avoid sodas.
- Make sure your child does not eat too much food that is high in salt, such as potato chips, french fries, or processed meats.
- A calcium-rich diet can help bind oxalate before it reaches the kidney. Encourage milk and yogurt.
- If your child is overweight, work with your child’s doctor to learn the safest way for your child to lose weight.
- Encourage water during sporting activities or other active playtimes.
RESOURCES:
Urology Care Foundation http://www.urologyhealth.org
CANADIAN RESOURCES:
References:
Kidney stones. Cincinnati Children’s Hospital website. Available at:
http://www.cincinnatichildrens.org/health/k/kidney-stones
Updated January 2011. Accessed June 25, 2013.
Kidney stones. National Kidney Foundation website. Available at:
http://www.kidney.org/atoz/content/kidneystones.cfm
Accessed June 25, 2013.
Nephrolithiasis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 17, 2013. Accessed June 25, 2013.
6/23/2014 DynaMed’s systematic Literature Surveillance
http://www.ebscohost.com/dynamed
Elderwy AA, Kurkar A, et al. Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: a prospective study. J Urol. 2014;191(5 Suppl):1491-1495.
Last Updated: 6/23/2014