Dr. Scott Hassell, a Plano urologist at North Dallas Urology Associates in Texas, shares some of the recent findings of the increasing cases of kidney stones in adolescents.

When Dr. Barry Duel, a pediatric urologist, began practicing years ago, it was rare to see a healthy child with kidney stones. Now, he sees two to three new children a month suffering from kidney stones. The significant increase prompted Dr. Duel to create a pediatric stone center at Cedars-Sinai Medical Center in Los Angeles, CA. Across the country, other new centers have emerged as doctors noted similar trends in pediatric cases.

"The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months," said Dr. Caleb P. Nelson, co-director of the new kidney stone center at Children’s Hospital Boston, MA who is a urology instructor at Harvard Medical School, "Now we see kids once a week or less."

Head of the department of kidney diseases at Children's Memorial Hospital in Chicago, Craig Langman has 800 pediatric patients in his records that have been diagnosed with kidney stones and over half of them occurring from the past five years.

The increase in pediatric patients has been attributed to poor diets, low calcium intake and childhood obesity. In the United States, the rise is associated to a host of factors, including a food additive that is both ubiquitous and legal: SALT. Excess salt has to be excreted through the kidneys, however salt binds to calcium on its way out, therefore creating a larger concentration of calcium in the kidneys and urine.

Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin, said "What we’ve really seen is an increase in the salt load in children’s diet." He, along with other urologists, stated that it is not just french fries and salty chips, but also processed foods: canned soups, packaged meals, sandwich meats and even popular sports drinks like Gatorade, which are common among children.

The tendency also is that children do not drink enough water. Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore, MD stated "They don’t want to go to the bathroom at school; they don’t have time, so they drink less." Unfortunately, we see that they are likely to drink only once they’re thirsty, however that may prove to be too late, or an insufficient amount especially for active children and those who play sports.

Kidney stones are small, hard masses of acid and mineral salts inour diet that separate from the urine and solidify in the kidney (nephrolithiasis). While there are many types that exist, the most common are made of calcium phosphate or calcium oxalate.

Typically, urine contains chemicals such as magnesium, pyrophosphate and citrate that work to prevent these crystals from forming. Patients that experience kidney stones can have low levels of these chemicals, thus attributing to the formation of kidney stones. Dehydration is another major factor, whereby a person lacks the fluid to flush the minerals that form kidney stones.

According to the National Kidney Foundation, approximately 1 million Americans are treated each year for kidney stones. Stones are found to be more common in men than women and affect those patients aging from 20 to 40s.

Specialists reveal that the occurence of kidney stones in children are caused by dietary habits, obesity and hereditary factors. Though infants can get kidney stones, statistics show that the median age at which they occur in children is typically around 10 years old.

Most urologists strongly believe that the increased amount of pediatric cases is directly linked to the rise in childhood obesity and poor dietary habits.

Too much dietary sodium.
Since most stones are made of calcium, an abundance of sodium causes the body to release more calcium into the urine. The rise in sodium intake in children's diet has several contributing factors: drinking more sodas and sports drinks vs. water, eating more fast food and the overall consumption of convenience foods.

Lack of dietary calcium.
A common misconception is that patients should avoid calcium. When in fact, it has been shown that dairy products reduce the risk of kidney stones, because the dietary calcium binds with oxalate before it is absorbed by the body, thus preventing it from entering into the kidneys. It is shown that children who have a 'low calcium intake' can cause their gastrointestinal tract to overabsorb the chemical oxalate, a component of kidney stones.

Obesity.
High levels of cholesterol, glucose, insulin and triglycerides affect the urine's acidity. UT Southwestern Medical Center in Dallas have shown in studies that patients with metabolic syndrome - characterized by high blood pressure, diabetes, high cholesterol and obesity - are at a higher risk for kidney stones. In particular, those people with high insulin levels, show a direct correlation with higher urine acid levels, which can attribute to the formation of uric acid stones. There is also strong evidence that sucrose, found in sports drinks and sodas, can also increase the risk of kidney stones, as can high protein weight-loss diets, which are popular among teenagers.

The majority of adolescent patients with kidney stones experience recurrent or severe pain in their side or stomach. In some instances, this may be accompanied by back pain, nausea or vomiting. As kidney stones move around, passing through the narrow ureter (whereby urine travels from the kidneys to the bladder), symptoms may become intermittent. The condition is harder to diagnose in younger children due to the vague description of what type of pain they are having, i.e. they feel sick to their stomach.

Children may have a fever when an infection exists. Symptoms in younger children are similar to those of urinary tract infections, with the presence of blood in the urine in some cases. Typically, it can be easily diagnosed through a urine sample analysis.

Kidney stone treatment is similar in children and adults. In cases of kidney stones in children, as many as 90% have a treatable cause, whereas in adults about 30% can be treated to prevent recurrence.

In children, the majority of kidney stones that are smaller than 6 millimeters will many times pass on their own. Parents are advised to be certain to have their child drink lots of fluids while waiting and give the appropriate amount of pain medication for the discomfort. However, surgery may be required where: a child is vomiting excessively, if it blocks the flow of urine, the kidney stones are too large, the pain is too intense, or there are signs of infection. In these cases, it can be removed by a urologist through one of two types of minimally invasive surgery. Shock-wave lithotripsy is a noninvasive method that uses high-energy sound waves to blast the kidney stones into fragments that are then more easily passed. Ureteroscopy, is a procedure that involves an endoscope that is inserted through the ureter to retrieve or obliterate the kidney stone.

Statistics reveal that 50 to 60 percent of adolescents with kidney stones have a family history of the disease. "If you have a family history, it’s important to recognize your kids are at risk at some point in their life," Dr. Nelson commented. "That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods."

"It’s no longer a middle-aged disease," Dr. Nelson stated. "Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population."

Since 1985, North Dallas Urology Associates have provided the highest quality adult and pediatric urological care throughout Dallas, Plano, McKinney, Richardson, Irving, Frisco and surrounding Texas cities. Across the United States, physicians and families have sought out the expertise of Doctor Hassell and his experienced staff to provide the most advanced urological treatment for their patients and loved ones!

J. Scott Hassell, M.D., Board Certified Urologist
DallasUrology.org

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