Summary
Nephrolithiasis, also known as kidney stones, occurs when solid crystals form in the kidneys and may move into the ureters, causing pain. While this condition is more commonly seen in adult men, its prevalence in children is increasing. Kidney stones can develop due to chronic dehydration, dietary factors, obesity, family history, certain medications, and metabolic abnormalities.
The most common symptom is renal colic, which is severe pain in the back or abdomen, though some patients may not experience symptoms. Treatment depends on the size, location, and type of stone, as well as the patient’s overall health.
For suspected kidney stones, an urgent ultrasound is the preferred diagnostic tool for children and pregnant individuals. For other patients, non-contrast CT can be used within 24 hours of symptom onset. Management may involve both medical treatments and surgical interventions based on the specific characteristics of the stones.
Diagnosis and When to Seek Help
Seek medical attention if your child experiences:
- Severe pain in the abdomen, back, or side (renal colic)
- Blood in the urine (hematuria)
- Painful urination or changes in urinary patterns
- Nausea or vomiting, which may accompany pain from kidney stones
In cases of suspected kidney stones, an ultrasound or CT scan will likely be performed to confirm the diagnosis and determine the stone’s size and location.
Management
The treatment approach for nephrolithiasis depends on the stone’s characteristics:
- Hydration: Ensure adequate fluid intake to help flush out smaller stones.
- Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers are used to manage acute pain.
- Medical treatment: Medications may be prescribed to help the stone pass more easily or to prevent new stones from forming.
- Surgical intervention: For larger stones or those causing severe symptoms, surgical procedures such as lithotripsy or ureteroscopy may be necessary to remove or break the stones.
A low-sodium, low-oxalate diet, and other dietary modifications may help reduce the risk of future stones.
Follow-Up and Monitoring
- Monitor hydration: Ensure that your child drinks plenty of fluids to prevent the formation of additional stones.
- Routine imaging: If stones are detected, follow-up imaging may be required to check for stone movement or recurrence.
- Dietary adjustments: After treatment, a specialized diet may be recommended to prevent future stone formation.
- Consider medications: In some cases, medications to alter the urine’s chemistry may be prescribed to reduce the risk of new stones forming.
With proper treatment and monitoring, most children with kidney stones can recover well, but it’s important to address any underlying risk factors to prevent recurrence.
History and Exam
Key diagnostic factor
- Acute, severe flank pain
Other diagnostic factors
- Risk factors
- Previous episodes of nephrolithiasis
- Nausea and vomiting
- Urinary frequency/urgency
Risk factors
- Dehydration
- High salt intake
- White ancestry
- Male sex
Diagnostic Investigations
1st investigations to order
- Urinalysis
- FBC and differential
- Serum electrolytes, urea, and creatinine
- Urine pregnancy test
Investigations to consider
- Stone analysis
- Plain abdominal radiograph (KUB)
- MRI
- Spot urine for cystine
Emerging test
- Dual-energy CT
Book an Appointment
Other Related Conditions
phimosis / circumcision
malformation of the kidney
disorders of sexual development
hydronephrosis
vesico-ureteral junction obstruction
vesico-ureteral reflux
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