Thursday, February 8, 2007

Kidney Stones in kids

Contrary to the misconception that only adults develop stones, it has been found that kidney stones also occur in children. This holds true for children living in hot climates or with any birth defects in their urinary tract.

A child may complain of burning on and off, while passing urine; may have backaches; Urine analysis may reveal presence of plenty of crystals, despite no complaints from the child. In the event of any of the above, your child may have Kidney stones!

In addition, you may notice some symptoms in your child pertaining to kidney stones, such as abdominal pain, hematuria (blood in urine), vomiting, backache, recurrent urinary tract infections or kidney stones may accidentally be discovered on USG (Ultrasonography). Diagnosis is made by plain X-ray of kidneys, ureters and urinary bladder or Ultrasonography.

Kidney stones in children are more problematic! This is so because kidney stones in children are frequently linked with an underlying anatomical abnormality such as spina bifida, a reconstructed urinary tract or augmented bladder. That means there's not as much experience in dealing with the problem and that treatment can be complicated.

Children with altered anatomy tend to make stones because of pooling of urine or infection. Unlike adults, young people usually must have stones removed, even when a child is asymptomatic. Odds are that the stones will eventually cause trouble, growing to obstruct the kidney.

Treatment of Kidney stones for children includes extracorporeal shock wave lithotripsy. For resistant stones, percutaneous therapy may have to be utilized. Small surgical instruments may be used for children to prevent risks of more involved surgery. The surgical procedure involves the insertion of a nephrostomy tube followed by a plastic sheath into the child's kidney. The sheath allows access of a nephroscope. Once the stone is sighted, other instruments, either a laser or miniaturized lithotripter can break it up.

For these procedures, Small children need general anesthesia, as they may not be able to tolerate the pain associated with the procedure. Children have a 20-50% higher chance for the stone recurrence. Problems like passing excess calcium in urine need to be detected and treated. Regular toileting and drinking plenty of water are essential to prevent urine infection and stone formation.

Table Salt should be restricted in diet. Non vegetarian foods and milk products need to be reduced. Cabbage, spinach, cashew, walnut etc need to be avoided. Coffee, tea, cola, apple and grape juices need to be restricted. Orange and lime juices are good. Vitamin D and calcium tonics should be avoided. With the advent of newer facilities, 95% of stones in children can be removed without open surgery. It is essential to consult a pediatric urologist trained in this area to get appropriate treatment.