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    Urolithiasis in children

    As the prevalence of stone disease has grown, so has the importance of understanding disease process, diagnosis, and management.

     

    Surgical techniques

    Although many stones will pass spontaneously, some children may require surgical treatment for their stones. Surgical techniques used in removing stones in adults are similarly successful in children. Children should be referred to a pediatric urologist or general urologist if they have stones that are generally larger than 7 mm to 8 mm, as these are less like to pass spontaneously; if their stones do not appear to pass in a reasonable time frame (generally should pass or move from the initial stone location on evaluation in about 4-6 weeks); or if the patient has a congenital or acquired anatomic abnormality increasing the risk of stone formation or decreasing the likelihood of passing the stones spontaneously.

    Treatment options include ureteroscopy with or without lithotripsy, percutaneous nephrolithotomy with or without lithotripsy, and extracorporeal shock wave lithotripsy (ESWL).5 Open and minimally invasive procedures also can be considered but are currently less often used in both children and adults.

    Interestingly, although ESWL is less successful when used in adults because of poor stone-free rates, ESWL treatment for renal stones in children, including fairly large stones, tends to be more successful when used in children and achieves reasonable stone-free rates (Figures 3 and 4).

    The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has a helpful information publication in English that explains kidney stone formation, management, and treatment that is available online for families and pediatrician offices at www.kidney.niddk.nih.gov (“Kidney Stones in Children,” NIH Publication No. 11-7383, September 2011).

    Summary

    Urolithiasis is becoming much more prevalent in children of all ages, and it needs to be treated aggressively with prevention. Many of these children will be seen by their primary care physician or nurse practitioner who needs to consider urolithiasis as a diagnosis in children presenting with gross hematuria as well as various degrees of abdominal or colicky pain.

    Prevention of stone recurrence depends upon ongoing increased hydration, limited salt intake, and improved dietary intake. Spot urine or 24-hour urine collection for stone risk will help determine certain dietary changes specific for metabolic abnormalities found on evaluation.

    Radiographic testing can diagnose stones in most children, however, limiting use of ionizing radiation is imperative to reduce lifetime risk of radiation exposure in children who are likely to have recurrence rates similar to adults.

    Next: Antibiotics, UTI, and VUR

    Most children will not need surgical intervention for their stone disease, but referral to pediatric urology may be necessary for large stones, complicated patient anatomy, and for stones that do not pass in a reasonable time period. The techniques used in adults work equally well in children.

     

    REFERENCES

    1.    Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324.

    2.    Copelovitch L. Urolithiasis in children. Pediatr Clin North Am. 2012;59(4):881-896.

    3.    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics; 2015.

    4.    Novenne A, Ticinese A, Morelli I, Guida L, Borghi L, Meschi T. Fad diets and their effect on urinary stone formation. Transl Androl Urol. 2014;3(3):303-312.

    5.    Hernandez JD, Ellison JS, Lendvay TS. Current trends, evaluation, and management of pediatric nephrolithiasis. JAMA Pediatr. 2015;169(10):964-970.

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