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Kidney stones in children

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Kidney Stones Treatment in Bangalore for Children | Nelivigi Multispeciality

The incidence of kidney stones in children is ever-increasing all over the world. Broadly speaking, the causes of kidney stones in children are the same as that in adults. The majority of them are composed of calcium oxalate and calcium phosphate.

The causes of kidney stones in children are the following:

  • Anatomical: Whenever there is a structural abnormality in the kidney like obstruction due to congenital abnormalities or acquired abnormalities, there is stasis of urine in the kidney. This leads to the growth of bacteria and subsequently urinary tract infections which are responsible for the formation of renal stones. About 20-25% of the stones in children are because of this factor.
  • Metabolic: About 80-85% of the stones are composed of calcium oxalate and calcium phosphate. These stones form because of the abnormality in the way our body handles calcium and oxalate. Both of them are present in the food we eat and absorbed through our intestines. . Normally the serum levels of calcium and oxalate are very finely regulated. This is done by varying the amount of calcium and oxalate absorbed and excreted in the urine. For some reason, if the body absorbs excess of these minerals or excretes too much of them in urine, calcium oxalate crystals are precipitated in urine and grow up to form stones.
  • Diet: Contrary to popular understanding, diet is responsible for only a small proportion of kidney stones. Some of the dietary deviations that cause renal calculi are excess salt, excess animal protein, lack of calcium (yes-lack of calcium!), and excess oxalate as found in spinach, tea, chocolates, etc.
  • Water intake: This is an important risk factor in stones formation. A well-hydrated person will not supersaturate calcium and oxalate in urine. There is also increased urine output which leads to excretion of calcium oxalate crystals in the urine and reduced acidity of urine.But it is not possible to set any target in terms of the volume of water intake as different children will have different capacities depending upon their age, body mass, their geographical settings, etc. The rule of thumb is to ensure adequate urine output.

Evaluation of kidney stones in children:

Ultrasound examination detects and characterizes most of the stones in the kidneys and the urinary bladder. Ureteric stones are diagnosed many times but not always. In case of uncertainty, either an x-ray or CT scan can be done. Basic blood tests and urine examination complete the evaluation.

Metabolic evaluation: These are specialized tests to evaluate the cause of the stones. It includes special tests of blood and urine for various components like calcium, oxalate, uric acid, citrate, and phosphate. The urine is usually collected for 24 hours and analyzed.

Kidney Stones Treatment in Bangalore for children:

ESWL (Extracorporeal Shock Wave Lithotripsy) is a technique wherein the renal stones are fragmented using sound waves. They are generated using a lithotripter. In children, this is done under general anesthesia or sedation. The stone pieces are passed out through urine over a period of a few weeks.

  • Ureteroscopy: Stones in the ureter are treated by inserting an endoscope through the penis and into the ureter. The endoscope is about 2 mm in diameter and the procedure is done under anesthesia.
  • PCNL (Percutaneous NephroLithotomy): A puncture is made in the back and an endoscope measuring about 5 mm in diameter is used to enter into the kidney and the stone is fragmented and removed.
  • Cystolithotomy: This is done for bladder stones. This can be done by a cut of 1 cm in the urinary bladder and the stone is fragmented and removed.
  • Medical treatment: Small ureteric stones can sometimes be treated by tablets and hydration.

Long term outcome:

Many children are recurrent stone formers because of the existing metabolic abnormalities. This is a distressing situation for the parents due to repeated hospital visits. However, with dietary modifications and adequate fluids intake, the risk of recurrence can be reduced if not totally prevented.

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