Kidney Stones in Children: Recognising Urolithiasis & Its Treatment

A] What is Urolithiasis?

Urolithiasis or pediatric urolithiasis refers to the formation of hard, crystalline deposits—commonly known as kidney stones—within the urinary tract. These stones are typically made of minerals like calcium, oxalate, or uric acid, which combine in the kidneys and form small, rock-like structures. Although kidney stones are more common in adults, children are increasingly experiencing this condition, often linked to lifestyle changes or genetic predispositions. The stones can range in size from tiny particles to larger formations, and when they move through the urinary system, they can block urine flow, causing pain, infection, or even kidney damage.

B] Risk Factors and Causes

1. Genetics

Family history is one of the primary risk factors for pediatric kidney stones. If close relatives have had stones, there’s a higher likelihood that a child will develop them as well. Specific inherited disorders, like cystinuria (where excess cystine is excreted in urine) or hypercalciuria (excess calcium in urine), significantly increase the risk.

2. Diet

Children who consume high amounts of sodium, processed foods, or diets rich in oxalates are at greater risk of kidney stones. Bladder stone causes include high sodium intake, which leads to increased calcium excretion in urine. This excess calcium can crystallise and form stones. Excessive sodium causes the kidneys to expel more calcium into the urine, which can crystallise and form stones. Foods such as spinach, nuts, chocolate, and even certain fruits can be high in oxalates, contributing to stone formation when consumed in large quantities.

3. Health Conditions

Children with recurring urinary tract infections (UTIs) or gastrointestinal issues like Crohn’s disease are at a higher risk. UTIs can lead to stone formation due to bacterial infections in the urinary tract. Metabolic disorders that impact the body’s processing of calcium, phosphorus, and oxalate also play a role. Additionally, conditions that reduce mobility can cause calcium to be released into the urine, contributing to kidney stones in infants.

C] Recognising the Symptoms of Urolithiasis

Recognising the signs of kidney stones in children is crucial for early diagnosis and treatment. Common symptoms include:

• Severe pain: Often in the back, side, or lower abdomen. In younger children, this pain might present as irritability.
• Blood in the urine: Known as Pediatric hematuria, this can make urine appear pink, red, or brown.
• Difficulty urinating: Painful or burning sensations during urination or the inability to urinate fully.
• Nausea and vomiting: Particularly when the stone obstructs the urinary tract.
• Fever and chills: Kidney stones and fever, often associated with a UTI, may occur if the stone causes an infection.

Given that some of these symptoms overlap with other conditions seeking medical attention is essential if they are present. If your child is experiencing any of these symptoms, do not delay and book a consultation with Dr. Gursev, a pediatric surgeon and urologist, for expert care and tailored solutions. 

D] Diagnosis and Tests

1. Imaging: Due to their safety and effectiveness, ultrasounds are the preferred first step in diagnosing kidney stones in children. In more complex cases, identifying urine stone symptoms may require urological tests such as X-rays or CT scans to locate the stone better and assess its size.
2. Lab Work: Urine tests help detect abnormalities like high calcium, oxalate, or uric acid levels. Blood tests can check for underlying metabolic issues contributing to stone formation. Collecting a passed stone for analysis is also beneficial for determining its composition and guiding future preventive measures.

E] Treatment Approaches

1. Conservative Management

For small stones, the main goal is to help the stone pass naturally. This involves increasing fluid intake to flush out the urinary system and prevent the stone from growing. Pain relief is crucial, so over-the-counter medications like ibuprofen or acetaminophen are often recommended. In cases where infection is present, antibiotics may also be prescribed. Early recognition of signs of kidney stones is essential to determine if conservative treatment is adequate.

2. Medication

Certain medications can be used to dissolve kidney stones or prevent their growth. For example, potassium citrate can be prescribed to alkalinize urine, preventing the crystallization of calcium-based stones. Additionally, diuretics are sometimes used to prevent the recurrence of stones by increasing urine output.

3. Surgical Intervention

When stones are too large to pass naturally or cause significant complications, surgical interventions may be necessary:

• Lithotripsy: A non-invasive procedure that uses sound waves to break the stones into smaller pieces, making them easier to pass.
• Ureteroscopy: A minimally invasive technique where a scope is used to locate and remove or break up stones lodged in the ureter.
• Percutaneous nephrolithotomy: A more invasive option reserved for very large stones, where the stone is removed directly from the kidney through a small incision.

Understanding the symptoms and treatments for kidney stones can help ensure that children receive timely care. Early diagnosis and management and dietary and lifestyle changes can reduce the likelihood of recurrence and lead to better long-term health outcomes.