Kidney stones, once primarily an adult condition, are increasingly observed in children. These mineral deposits can form in the urinary tract, causing discomfort and potentially obstructing urine flow. Various effective treatment approaches are available to manage the condition and help children recover.
Conservative Management
When kidney stones are small, typically less than 5 millimeters, and not causing severe symptoms or complications, conservative management is often the initial strategy. This approach focuses on natural stone passage through increased fluid intake and pain control. Encouraging the child to drink ample water, aiming for pale urine, helps dilute the urine and flush the stone. Water is preferred, though some citrus drinks like lemonade, which contain citrate, may also be beneficial.
Pain management is important, as passing a stone can cause discomfort. Over-the-counter medications like ibuprofen or acetaminophen are often sufficient. For severe pain or vomiting, stronger medication or intravenous fluids may be given in a hospital. Healthcare providers may also suggest using a strainer to collect the passed stone for analysis, which helps determine its composition and informs future prevention strategies.
Minimally Invasive Procedures
For kidney stones that are too large to pass on their own, cause significant pain, or obstruct urine flow, minimally invasive procedures offer effective solutions. These techniques break down or remove stones without requiring traditional open surgery. Two common methods include Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy.
ESWL uses shock waves generated outside the body to break kidney stones into smaller fragments. These shock waves are often guided by X-rays or ultrasound to fragment the stone into pieces small enough to be passed naturally. The procedure is non-invasive, typically performed under anesthesia, and usually takes about 45 minutes, allowing children to often return home the same day. ESWL is a primary treatment option for upper urinary tract stones generally smaller than 2 centimeters due to its effectiveness and low complication rates.
Ureteroscopy involves inserting a thin, flexible scope through the urethra and bladder into the ureter or kidney to visualize the stone. Once the stone is located, a laser or other specialized tools are used to break it into smaller pieces, or the stone may be removed directly with a small basket. This procedure is typically performed under general anesthesia and is suitable for small to medium-sized stones in the ureter or kidney. A temporary ureteral stent may be placed after the procedure to help with healing and drainage, remaining in place for a few days to several weeks.
Surgical Options
When kidney stones are large, complex, or resistant to less invasive methods, surgical intervention may be necessary to ensure complete stone clearance. Percutaneous Nephrolithotomy (PCNL) is a common surgical approach for such cases in children.
PCNL is a minimally invasive inpatient procedure performed under general anesthesia. A small incision is made in the child’s back, through which a urologist can access the kidney directly. Scopes and energy devices, such as lasers or ultrasound, are then used to break up the stone and remove the fragments. This technique is effective for large kidney stones, including those over 20 millimeters, or stones located in the lower part of the kidney. After PCNL, a temporary drainage tube, such as a nephrostomy tube or ureteral stent, may be left in place for a few days to facilitate healing and urine drainage.
Preventing Recurrence
Preventing the formation of new kidney stones is an important part of long-term management for children who have experienced a stone. This involves a combination of lifestyle adjustments, dietary modifications, and sometimes medication, tailored to the specific type of stone. Identifying the stone’s composition through laboratory analysis is a first step in guiding these preventive measures.
Adequate hydration is a fundamental preventive strategy for all types of kidney stones. Children should drink enough fluids, primarily water, throughout the day to keep their urine diluted, which helps prevent mineral concentration and crystal formation. Dietary changes are also often recommended. These may include reducing sodium intake, as high sodium can increase calcium levels in urine.
Depending on the stone type, limiting foods high in oxalate (such as certain leafy greens, nuts, and chocolate) or moderating animal protein consumption might be advised. Maintaining adequate calcium intake from food sources is recommended and can help prevent some stone types.
In some cases, medications may be prescribed to prevent recurrent stone formation, especially for children with specific metabolic imbalances or a history of multiple stones. These medications can include potassium citrate to increase urine citrate levels or thiazide diuretics to reduce calcium excretion. Regular follow-up care with healthcare providers, including periodic urine tests and imaging, is also important to monitor for new stone formation and adjust prevention strategies as needed.