Kidney stones were very rare among children or teens and is now increasingly common. The annual incidence of kidney stones has gone up in the recent years and has almost doubled in children. In contrast to the more common occurrence of kidney stones in men than in women during middle age, teenage girls have a higher rate of kidney stone occurrence than boys of the same age group. In comparison, more girls within the age of 10 to 24 years are affected and more men of 25 years and above. These facts are particularly concerning when medical evidence reveals that kidney stones are associated with a higher risk of chronic kidney disease, cardiovascular disease and bone disease, particularly among young women. All the more worry is because there are also limitations on parent’s consent for treatment options in children with kidney stones.
There are many factors that contribute towards the rise in kidney stone rates. Dietary factors are considered to be the major causative agents for kidney stones in adolescents. Dietary irregularities such as, not drinking enough water, poor eating habits with increased salt and decreased calcium intake are among the many. In a larger picture, the major contributor to the increase in kidney stones is excess intake of salt. For adults, the recommended daily allowance of sodium is a maximum of 2300 mg. Adolescents should consume much less and maximum consumption can vary based on the child’s size. A teenage boy or girl of half the body size of an adult can be allowed to consume only half the recommended intake for adults. More so, yet another concern is that teenagers are not eating enough fruits and vegetables, which contain potassium to counteract sodium. It is this disproportionate content in sodium and potassium that may result in excess of calcium to trigger kidney stones.
Not drinking enough fluids can cause dehydration and urine to become extra-concentrated increasing the chance of crystals forming in the kidneys. There is fluid requirement for constant flushing and emptying of the kidneys. In the absence of sufficient fluids, excess minerals start collecting within the cavities of the kidneys rather than being passed out. Urine should be clear, if the child is drinking enough water. Though in most children and teens, kidney stones are due to the diet and/or amount of fluid in the diet, there may be other underlying reasons for the development of kidney stones. Most teens have an increased risk of developing kidney stones because of health conditions such as:
- Family inherited disorders
- Blockage of urine flow due to structural defect of the urinary tract
- Kidney infection
- Metabolic disorders
The sudden complain of pain in the back or side of the hip is the most common sign. The pain is usually constant and severe following the pattern of waves termed as “colicky”. Nausea and vomiting may be accompanied. This pain may move along to the groin as the stone passes down the urinary tract. Children with kidney stones are usually unable to locate where the pain is and just complain of stomach or abdomen pain. Many children, specially the younger ones will have no pain at all and the stones may get discovered during the investigation of an urinary tract infection or as a random finding on an X-ray or ultrasound study done for a different reason. The rubbing of the stones against the ureter may cause bleeding in the urine. The presence of blood in the urine can miss the naked eye and may be detected only in a urine sample testing as “microscopic haematuria”.
Symptoms usually do not present until the stones start moving around in the kidney or pass into the ureter. Mostly, small stones may move through the urinary tract and get passed out of the body with no problems but stones that are bigger in size can block the urinary tract and cause symptoms like..
- Sharp pain that starts in the pelvic region
- Pain that radiates down to the lower belly and groin as stones move through the urinary tract
- Pain that appears in wave
- Red- or brown-coloured urine
- Nausea and vomiting
- Often, urgent need to urinate
- Fever and chills at times
Examination and history of the symptoms and it’s duration are the ways for a doctor to consider the chances of kidney stones in a teenager. The doctor may also try to find out from parents about the lifestyle, dietary habits and family medical history to know the possibilities of other diseases or conditions that affect the kidneys or urinary tract. To arrive at a diagnosis for kidney stones, blood tests, urine tests or kidney function tests may be primarily necessary. Imaging tests such as an ultrasound or CT scan can show a stone’s size and location. These details help the doctor to provide the best suitable treatment.
Usual treatment plan followed by urologists for kidney stones is to decide and proceed on the basis of the stone size, location and type. In case of children, options for treatment without surgery are convincing for parents. Small kidney stones may be passed through urine without invasive treatment. Children may be asked to urinate through a strainer for a few days to catch the kidney stone in a special container. The kidney stone is sent for laboratory testing to find out what type it is. It is absolutely necessary for children to drink plenty of liquid to help move a kidney stone along. The health care provider may also prescribe medicines to relieve pain. Bigger kidney stones or the presence of many stones that can block a child’s urinary tract or cause great pain, would need urgent treatment. A child with vomiting and chances of getting dehydrated, may need to be hospitalised to ensure getting Intravenous fluids.
If surgery is the only option left, the urologist may perform the least invasive surgery needed to break and remove the stones from the child’s kidney.
Techniques with minimal complications and safer recovery rates are chosen over others. Common procedures opted for would be Shock wave lithotripsy, Ureteroscopy, Laser lithotripsy, percutaneous nephrolithotomy or Retrograde Intrarenal surgery to get rid of the stones. The child may need a day’s stay at the hospital to ensure postsurgical care. A strict follow up is required with complete preventive measures to avoid recurrence of kidney stones. Once a stone is passed or removed, there are high chances of similar stone formation in the absence of enough urine output and increased levels of minerals. Frequent urine analysis at regular intervals may be needed to plan better kidney stone management. Suggested changes in the teen’s eating and drinking habits are vital. To know the cause of kidney stones in the first place and rule out such causative factors would be the most wise management skills to prevent repeat of kidney stone formation. Parents, in coordination with the doctor’s guidelines can bring about desired changes necessary for teen’s healthy and stone free living.