Kidney Stones in Children: Follow-up and Prevention (4 of 5)

By: The Children's Hospital of Philadelphia

Once a patient either passes a stone on their own or the stone was removed surgically, then our team really goes into the management mode. The best way to unravel the mystery of what's causing the stone is to actually isolate or identify what the kidney stone is composed of. In reality, that's actually very difficult unless it's removed surgically. Almost always, if a child passes a kidney stone it's not able to be captured and analyzed.

So even if you don't have the stone, you can collect a full days' worth of urine and send it to the lab, and they'll measure all the various factors that can promote stones or inhibit stones, and then that can also often give us sort of a mirror of what that stone would look like if we caught it. If the stone can be captured and analyzed chemically, it can basically tell us whether it is a calcium-based stone, which up to two-thirds of kidney stones are in childhood, or a rarer type stone in which case a rare metabolic cause is usually much more likely. Once we fingerprint the reason why stones are forming in any individual patient, we can immediately work toward medical management of the stone disease for this particular child. There are several medications, which can be used to decrease the risk of stone recurrences. The most common medications we use are ones which have the ability to decrease the amount of calcium which is excreted in the urine and also increase the amount of urine that the patient makes. Another class of medications we use contain something called citric acid, which is found in fruits and vegetables, but they come in the medication form in very high doses, higher than can often be consumed in nature, and can prevent kidney stone formation that way.

You're always going to have genetic or metabolic reasons that you can inherit, but we're finding a lot of the kids that come into our stone center, it's really the environment that's around us now and the life they lead. They're busy. They're not drinking a lot of water.

They're eating and drinking a lot of different things than we had 100 years ago, a lot of things with increased sodium. Prevention of recurrence is all about habits and changing those habits is key. It often involves making dietary recommendations. Today, I'm going to talk to you a little bit about how what you can eat will help with your kidney stones. The average child these days does not get enough water intake, and the stone former needs to drink double that.

Kidney Stones in Children: Follow-up and Prevention (4 of 5)

So what they need to do is drink enough water that their urine is clear throughout the day. Water is definitely the best choice. Cranberry juice and lemonade are okay too, but water would definitely be the best thing to drink. When the doctors told us how much water she should be drinking, that was a shock because we know that she hadn't been. So that was something easy for us to change, but for a 6-year-old girl, 7-year-old girl, and being told that she has to drink over 50 ounces of water a day, that was hard. Another important thing is avoiding salt. People are often unaware about the high sodium content that exists in most foods, particularly in a child's diet or an adolescent's diet.

The stone former may have to avoid certain types of foods that may be healthy in someone else's diet, foods that are high in oxalate such as dark leafy green vegetables. Some things that kids really love like chocolate, I may have to educate them that you can have these foods still, but you really have to eat them in moderation. Along with dietary modification we also encourage the child to be… to have an active lifestyle. Part of what we're doing is getting people into the mindset. It's not just the patient.

You've got to retool the way the family thinks about their entire environment. Any kind of lifestyle change, especially a nutrition lifestyle change can be very challenging. We do the best that we can to help support you in the lifestyle change and many of our families have been able to do this, and their children are doing well. I'm more responsible with my medicine. My mom doesn't need to remind me to take it. As far as the everyday dealing with knowledge that she has a kidney stone, it doesn't affect her. I'm so proud of her with that.

My husband and I both are. We really work together and talk about, you know, this is what we think needs to be done, how can that fit into your lifestyle, do you understand our rationale for wanting to do this, so it really is a partnership. Equally important, we communicate directly with the referring physician through both letters and conversations.

So we're very conscious of trying to make sure we keep communication wide open between the nephrologist and the urologist, and the providers here at CHOP with the child's primary care pediatrician who often knows that child and that family even better than we do. Although the incidence of stones is increasing in children, it's still relatively rare compared to the adult population and when you're dealing with a rare disease the most important thing is that you have experts treating your child. The volume of patients – of pediatric patients – with stones that we see really puts us in an enviable position to collect data, both clinical data and laboratory data, on pediatric stone disease and try and understand it in a way that hasn't been done before. So that the family and the child knows as much as we can possibly provide to them about why they got their stone, how we're going to deal with the stone, and how we're going to prevent them from ever having to deal with a stone again.

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