Kidney stones

The highest concentration of Americans with kidney stones come from what we refer to as the "Stone Belt" in the southeastern states. This is probably due to the warm weather in those states, which can cause mild dehydration.

Symptoms

What are the symptoms of kidney stones?

Symptoms may vary from none, in the case of “silent stones,” (stones that are still in the kidney and have not moved to the ureter) to severe pain due to urinary obstruction.

Here’s a list of the most common symptoms of stone disease:

• pain in the abdomen, flank (side), back, or groin
• blood in the urine
• frequent urination
• nausea and/or vomiting

Keep in mind that kidney stones affect different children in different ways.

Any child with pain accompanied by blood in the urine — even if it’s just a little bit — should be evaluated by a doctor.

Causes

What causes kidney stones?

Kidney stones form when there is too much of the mineral ingredients of the stone and not enough water in the urine.

This can occur either because there is an abnormally high mineral content in the urine, or the urine is too concentrated because of dehydration.

Some rare stone diseases can result from inborn metabolic problems, which means that your child has a genetic condition that causes his body to make these stones. A family history of kidney stones predisposes other members of the family to have stones.

Children who can’t move for long periods of time (in traction after surgery, for example) may also be susceptible to stones, because when bones are inactive, they’re unable to regenerate themselves properly, which results in calcium being flushed into the system.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child is suffering from kidney stones and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need. You may want to suggest that your child write down what he wants to ask his health care provider, too.

Some of the questions you may want to ask include:

• Can my child pass these stones on his own?
• What are our treatment options?
• What sort of dietary changes do we need to make?
• What can we do to encourage our child to drink more water?
• Where can we go for further information?

Keep in mind that your doctor will want to ask you some questions, too. These can include the following:

• Is this your child’s first stone?
• Is there a history of stone disease in the family?
• How much water does your child drink each day?
• What’s your child’s diet like?

FAQ

Q: Why are kidney stones a problem?

A: They can get lodged in the urinary tract and obstruct the flow of urine. Although most stones won’t cause long-term damage to your child, passing kidney stones can be extremely painful.

Q: What causes kidney stones?

A: Kidney stones form when there is too much of the mineral ingredients of the stone and not enough water in the urine. This can occur either because there is an abnormally high mineral content in the urine, or the urine is too concentrated because of dehydration.

Some rare stone diseases can result from inborn metabolic problems, which means that your child has a genetic condition that causes his body to make these stones. A family history of kidney stones predisposes other members of the family to have stones.

Children who can’t move for long periods of time (in traction after surgery, for example) may also be susceptible to stones, because when bones are inactive, they’re unable to regenerate themselves properly, which results in calcium being flushed into the system.

Q: How common are kidney stones? 

A: Stones are not common in children, but they're getting more so.

Some children who form urinary stones have an underlying abnormality of the urinary tract. These can include obstructions of the kidney and ureter (the tube that connects the kidney with the bladder) or diseases such as spina bifida.

However, most children with stones have normal urinary tract anatomy. We believe that the increase in kidney stones may reflect lifestyle factors such as childhood obesity, diets with excess salt and not drinking enough water.

Q: What are the symptoms of kidney stones?

A: Symptoms may vary from none, in the case of “silent stones,” (stones that are still in the kidney and have not moved to the ureter) to severe pain due to urinary obstruction.

Here’s a list of the most common symptoms of stone disease:

• pain in the abdomen, flank (side), back, or groin
• blood in the urine
• frequent urination
• nausea and/or vomiting

Keep in mind that kidney stones affect different children in different ways.

Any child with pain accompanied by blood in the urine — even if it’s just a little bit — should be evaluated by a doctor.

Q: How are kidney stones diagnosed?

A: Our doctors can tell if you child has a kidney stone by looking at his urinary tract with ultrasound or a CT scan.

Ultrasound is our first choice of diagnostic because there’s no radiation exposure. If the ultrasound is inconclusive — or if your child’s doctor has any questions about it — we might do a CT scan. A CT scan can also be used to help your child’s doctor locate the exact position and size of the stone for surgical planning.

Q: How are kidney stones treated?

A: The best treatment will depend on the size, location, number and composition of your child's stone(s). In many cases, stones can be passed spontaneously without any treatment — in fact, children can pass stones that are relatively large compared to those that adults can pass.

Your child's doctors may prescribe certain medications that have been shown to increase the chance of a stone passing spontaneously.

Q: What if my child can’t pass the stone himself?

A: Sometimes it is necessary to remove the stones if warranted by your child's condition and symptoms. It also makes sense sometimes to remove a growing stone even if it is causing no symptoms, rather than waiting until it is very large.

The choice of technique depends upon the location, size and type of stone, as well as your child's anatomy. Methods include, the following, which are described in the Treatment & Care section:

• extracorporeal shock wave lithotripsy (ESWL)
• percutaneous nephrolithotomy (PCNL)
• ureteroscopy
• open stone surgery

Q: What is the long-term outlook for my child?

A: It depends on what’s causing your child to develop the stones. Some children pass a stone, change their diet and hydration patterns and never have another stone again. Others, however, have trouble changing their hydration and eating habits and will probably develop more stones.

Rarely, a child may have an underlying medical condition that causes the body to develop stones; in this case, your child may have to struggle with stones for the rest of her life.

Q: How do I make sure my child doesn't get more stones?

A: Here’s a list of some basic things you can do to decrease your child’s chances of developing kidney stones:

• Encourage your child to drink plenty of water, not only when he is thirsty, but through the day. Keeping hydrated is extremely important.
  • An excellent way to determine if your child is properly hydrated is by checking the color of his urine; if it’s clear, he’s adequately hydrated, but if it’s yellow, he’s dehydrated.
  • Many sport drinks have added sodium, so be sure to check the label before drinking them and avoid drinks with high amounts of sodium. Water is always the best way to stay hydrated and decrease your child’s chances of developing stones.
  • Citrate is generally good to have in the urine. We encourage children to drink lemonade because it may be a source of natural citrate.

• Avoid salty foods like chips, French fries, processed meats, canned soups, prepackaged meals and high-fat items. To cut salt intake, leave the saltshaker off the kitchen table and do not add salt to food while cooking.

• Focus on providing a healthy diet high in fruits and vegetables, and be sure to include the recommended daily allowance of protein, calcium and vitamin D.

• Exercise, exercise, exercise! Although fit children can develop kidney stones, many experts believe obesity may be related to higher incident rates. Make sure your child keeps hydrated while exercising.

• If there is a family history of kidney stones, pay extra attention to diet, exercise and water consumption.