Urinary (Kidney) Stone Disease in Children

Urinary Stone Disease - Urinary (Kidney) Stone Disease in Children

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Our Approach to Urinary (Kidney) Stone Disease in Children

The pediatric urologists at The Columbia University Department of Urology at The Children's Hospital of New York are experts at diagnosing and treating pediatric kidney stones, including complex conditions such as staghorn calculi, cystine stones, stones refractory to shock-wave lithotripsy, and recurrent kidney stones. We offer patients an all-inclusive approach to treating urinary stone disease with the latest technological treatment advances.

Treating kidney stones in children is challenging because they can result from a wide range of underlying problems. Genetic risk is very common among stone-forming children but many other poorly understood factors can contribute to stone development. Calcium oxalate and phosphate stones, account for 80% to 90% of all pediatric urinary stones. These are usually a combination of both but can be pure calcium oxalate or calcium phosphate.

Diagnosis of Urinary (Kidney) Stone Disease in Children

Stones can lodge in any part of the urinary system. To locate them urologists use imaging tests including x-rays, ultrasound, or computerized tomography (CT) scan. Depending on size, many stones can pass on their own in the urine. Because urologists base long-term treatment and prevention plans on the composition of the stone, it's important to save all stones and fragments for evaluation. To catch a stone, patients should urinate into a strainer.

Treatment for Urinary (Kidney) Stone Disease in Children

Treatment approaches for kidney stones depend on their size and whether they are causing pain or obstructing the urinary tract. Small stones (less than 3-4 millimeters) can sit in the kidney for months or even years without causing any pain or damage. Urologists may decide not to treat these stones. Once stones grow larger than 3-4 millimeters urologists usually treat them even if they are not painful, as these stones can move into the ureter and block the flow of urine, causing severe pain. Some large kidney stones, called staghorn stones, are painless but very dangerous because they can silently cause kidney failure.

Most stones pass out of the body on their own. Those that do not can usually be eliminated with either minimally invasive or non-invasive treatment.

Extracorporeal shock wave lithotripsy (ESWL):
ESWL is a completely non-invasive treatment during which doctors focus shock waves from outside the body on the kidney stone. These waves break most stones less than three-quarters of an inch across into tiny fragments. The particles easily pass out of the body in the urine.

Some stones cannot be treated with ESWL because of their size, location, composition, or coexisting medical conditions. In most cases doctors can manage these using a minimally invasive technique called ureteroscopic laser lithotripsy. While the patient is under anesthesia, urologists pass a tiny, pediatric sized, fiberoptic camera into the urinary tract through the urethra to the location of the stones in the bladder, kidney or ureter. Our urologists use a state-of-the-art device, the Holmium-YAG laser, to fragment and vaporize the stone into miniscule pieces, which are then flushed out of the body.

Percutaneous Lithotripsy (Percutaneous Nephrolithotomy):
To treat very large stones or those that can't be treated with other methods, Columbia urologists may use percutaneous lithotripsy (percutaneous nephrolithotomy). In this procedure, a tiny incision is made in the flank through which a camera is passed into the kidney. They can then fragment the stones using ultrasonic or laser lithotripsy. This procedure is commonly used in adults, and recent studies have shown that it is also safe in children.

Prevention of Urinary (Kidney) Stone Disease in Children

Urinary stones develop for many reasons and the solutions can be complex. To determine the underlying cause of recurrent stone disease we perform a metabolic evaluation and extensive blood and urine studies. This information helps us determine which dietary modifications and medications will prompt the stone to dissolve and most effectively prevent the stone disease from progressing.

People who have had one kidney stone are more likely to develop others. Without preventive treatment or changes in lifestyle, patients can develop a new stone within a year or two of the first one. About half of patients develop another stone within 5 to 10 years, and 80% will at some time in their lives. To help lower the chance of that a patient will develop another stone, doctors recommend the following measures.

Hydration:
People who have had a stone should drink 64 ounces of water throughout each day. Drinking plenty of fluids also reduces the risk of urinary tract infections - a major cause of some stones.

Dietary Changes:
Depending on the composition of the stone and the results of laboratory tests, doctors may advise patients to eat less meat and table salt.

Medication:
Some patients with stones benefit from prescription medications. Doctors may prescribe diuretics such as hydrochlorothiazide to decrease calcium excretion. Potassium citrate binds calcium and helps to remove it safely. Allopurinol reduces the risk of forming uric acid or calcium oxalate stones.