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Nephrolithiasis (Kidney Stones)

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

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    Other Related Conditions

    urinary tract infections

    continence & bedwetting

    phimosis / circumcision

    malformation of the kidney

    penile abnormalities (hypospadias, epispadias)

    disorders of sexual development

    scrotal issues (undescended testis, hernias)

    Hydrocele in Children

    hydronephrosis

    vesico-ureteral junction obstruction

    vesico-ureteral reflux

    tumors (kidney, testis)

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

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      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com