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Kidney Stones in Children
31 May 2022

What Is a Kidney Stone?

Kidney stones are hard as a rock and form in the kidney. While rocks tend to be small in children, size doesn’t contribute to how bad the symptoms can be. When a high concentration of crystal-forming substances—such as calcium, oxalate, and uric acid—is present in urine and “stick together,” forming into a rock.

Who Gets Kidney Stones?

Kidney stones are more common in adults but occur more often in kids. While there isn’t an exact reason, diet or obesity may play a role.

Kidney stones are also more common in warmer climates, especially when you get to the equator, also known as the “stone belt.” As people sweat more and urinate less, the urine can become more concentrated. Stones also have a strong genetic predisposition and tend to run in families.

How Do Kidney Stones Cause Problems?

Kidney stones are made in the renal pelvis, where urine collects before draining into the ureter, and it goes into the bladder and then urinated out through the urethra.

Kidney stones usually don’t hurt when they’re floating around in the kidney, and the pain happens when a stone falls into the ureter to make its way out. The ureter is a small, delicate tube made to pass urine, and it’s even smaller in kids.

When a stone makes its way in there, it blocks the flow of urine from the kidney and causes everything behind the stone to swell, which causes pain. Kidney stone pain is usually the same every time—very severe, sudden onset pain on one side with vomiting. Sometimes, there’s blood in the urine.

The pain can move from the side to the groin as the stone makes its way out. Whether a stone pass depends on its size and internal anatomy, and stones can get stuck on their way out.

How Do I Know If Child Has a Kidney Stone?

It’s hard to tell if anyone has kidney stones only from a history and physical exam. Although kidney stone pain always presents the same way, there are several causes of similar pain. Often, a doctor will conduct an ultrasound, x-ray, or CT scan. Your child should see a doctor or go to the ER if they are experiencing severe abdominal pain.

What Do You Do About a Kidney Stone?

If the stone is not causing symptoms, Generally, it’s best to let stones pass on their own when they are small enough and there are no other complicating issues. Small stones may be observed closely with imaging studies every few months. Surgery may be recommended for more giant stones that cannot pass on their own or for children with other issues where observation may not be a great idea.

If the stone is already making its way down the ureter, there may be a good chance the stone passes on its own depending on its size, and your urologist will follow it closely to make sure it gives. This approach is called expulsive medical therapy.

Your child may be prescribed pain and nausea medicine to help with symptoms and a medication that may help stones in the ureter pass out easier called tamsulosin.

It’s essential to catch a stone by straining the urine every time your child urinates—during the day, night, and at school. Although stones cause a lot of pain and headaches, they tend to be very small. Pain goes away when the stone makes it to the bladder and causes no discomfort when coming out of the urethra, so they are commonly missed when kids aren’t on the ball with straining. Catching the stone allows you one step closer to preventing another stone from forming by sending it for analysis and letting your doctor know the stone is out. Sometimes children can have aches and pains for a few weeks after passing a stone, making it tricky to see if it’s passed when the stone wasn’t caught.

Pain from kidney stones gets less severe and can even go away with time, even if the stone hasn’t passed. But it can be dangerous if ignored because a long-term blockage will cause the kidney to stop working. Medical expulsive therapy can take about four weeks before permanent damage to the kidney, so close follow-up is recommended.

Medical expulsive therapy isn’t always the best choice for every patient. Stones that are too big aren’t going to pass any matter you wait. Reasons to go to the emergency room while letting a stone pass include pain or nausea that can’t be controlled with oral pain medicines.

Additionally, a fever in the setting of a kidney stone passing is a fundamental reason to go to the emergency room as soon as possible as it can suggest a kidney infection. This can result in severe illness if not addressed.

What Are Options to Remove Kidney Stones?

Some stones can be too big, stuck for too long, or because of other problems were waiting may not be an option. There are several ways to remove kidney stones, and the best method depends on a conversation with a pediatric urologist.

  • Extracorporeal Shock Wave Lithotripsy (ESWL)
    Extracorporeal Shock Wave Lithotripsy, or ESWL, is the least invasive method and breaks stones with shock waves applied outside the body. There are no cuts. The doctor targets the stone with x-rays, breaks the stone, and then the tiny fragments or dust pass in the urine. Children go home the same day and can get back to normal activities within a few days.
  • Ureterostomy
    ureterostomy, the most common stone surgery performed in children, involves passing a tiny camera through the urethra up the ureter to the stone. It’s then broken into small pieces and removed with a unique basket. However, it’s widespread to place a small, temporary stent in the ureter before doing a ureterostomy because the ureter is small and delicate, especially in kids, and may not be able to accommodate the scope safely. A stent gently stretches the ureter for 1-2 weeks, allowing the ureterostomy to be performed. Kids also go home the same day, and a temporary internal ureteral stent is usually left in place for a few days after ureterostomy.
  • Nephrolithotomy (PCNL)
    Nephrolithotomy, or PCNL, is reserved for large stones or complicated situations. A small ½ inch cut is made in the back, just over the kidney, and a camera the width of a pen is passed directly into the kidney to break and remove the stone. Children usually stay in the hospital overnight. Additionally, this surgery is often performed in 2 stages.

The Stone Is Removed, What Now?

Getting the stone out is the first step in this problem. Children who form stones are almost guaranteed to develop more stones at some point in life. The next step after passing a stone is to figure out why it happened. After the first stone episode, a metabolic workup in kids, specifically blood work, and a detailed 24-hour urine study. These tests give us a more specific answer as to why the stones formed and what exactly needs to be done to prevent more from forming.

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