According to the National Institutes of Health (NIH), 1 out of every 10 people will develop kidney stones during their lifetime. Renal stone disease accounts for 7-10 out of every 1,000 hospital admissions. Although kidney stones are most prevalent in adults, they are on the rise in pediatric patients.
Our Division has seen tremendous increase in the number of children with stone disease. In 2000, about four office visits per week focused on stones. In 2010, this number more than doubled to reach 10 visits per week. Until recently, these patients were primarily treated in adult healthcare institutions, which has been associated with increased morbidity. Studies have shown that specialty care for stones improves patient outcomes including less time in the hospital, less recurrence and faster return to school and childhood activities.
To meet the increasing need for specialized care for children with stone disease, we created a cutting-edge Pediatric Stone Center to provide multidisciplinary evaluation and management. Our center utilizes state-of-the-art treatment modalities in urinary stone disease including incisionless stone ablation with shock waves and lasers, as well as minimally invasive surgery performed by laparoscopic and robotic techniques.
A multidisciplinary team to evaluate, treat and help prevent stone disease – Our team is led by Thomas Kolon, MD and Kerry Ashcroft, CPNP. We partner with the nephrology team, Madhura Pradhan, MD and Lawrence Copelovitch, MD, to help ensure that your child’s medical and nutritional needs are being met. In some instances we also work with our colleague in metabolism, Paige Kaplan, MD, to treat the underlying metabolic disorder that may predispose your child to stone disease. This multidisciplinary collaboration also includes radiologist and anesthesiologists. It is through these successful partnerships that we have reduced the burden of stone disease and improved quality of life for our patients and families.
Improved patient outcomes – It is vital that patients are assessed appropriately and referred to the proper team members for management. We work closely with our partners in nephrology and metabolism to ensure patients receive the necessary treatments across the continuum of care. We developed a treatment algorithm to ensure that necessary — but not extraneous — tests and referrals are made promptly. Most recently, we partnered with our emergency department to create a standardized clinical pathway for the evaluation of children with a suspected urinary tract stone in the acute setting. This pathway was designed with input from members of the urology, radiology and emergency department teams.
Expanded educational programs for frontline providers to increase knowledge of the presentation and treatment of pediatric stone disease – Our colleagues in primary care are seeing more and more children with stone disease. It is vital to stay up to date on the latest research and have a good understanding of the diagnosis, management and prevention of stone disease. We routinely conduct educational programs at local pediatric practices to ensure the information is getting to primary care providers and to answer any questions providers may have.
Enhanced clinical and basic research initiatives for patients with stone disease – A critical part of our mission is documenting our care and outcomes so we can better understand the factors that influence the development and recurrence of stone disease.
We utilize all available methods to treat active stone disease and try to prevent recurrent stones.
Treatment depends on the size and type of stone, the underlying cause, the presence of urinary infection and whether the condition recurs. Stones 4 mm and smaller (less than 1/4 inch in diameter) pass without intervention in 90 percent of cases. Those 5-7 mm pass without intervention in 50 percent of cases. Those larger than 7 mm rarely pass without intervention.
If possible, the kidney stone is allowed to pass naturally and is collected for analysis. Your child is instructed to strain his urine to obtain the stone(s) for analysis.
If a kidney stone does not move through the ureter within 15 days, if fever develops or if the pain doesn't improve, surgery is considered. We use several procedures to break up, remove or bypass kidney stones. These procedures include:
Our center places a lot of emphasis on trying to prevent kidney stones. Prevention of renal stone disease depends on the type of stone produced, underlying risk factors of urinary chemical and your child's willingness to undergo a long-term prevention plan. Your child may need to make lifestyle modifications such as increased fluid intake and changes in diet.
We recommend children with stone disease drink a minimum of half of their body weight in ounces of water daily (e.g., an 80-pound child would drink 40 oz. of water). Proper hydration helps prevent the urine from becoming concentrated with crystals, which can lead to stone formation. It also reduces the risk for urinary tract infections, which may lessen the risk for struvite stones (stones associated with a urinary tract infection). Urine color may indicate the level of concentration: dark or bright yellow urine indicates highly concentrated urine, whereas pale or colorless urine indicates less concentrated urine. Lemonade with real lemon juice is a good source of citrate and may be recommended as an alternative to water.
We may also recommend limiting meat, salt and foods high in oxalate (e.g., green leafy vegetables, chocolate, nuts) in your child's diet. We may prescribe medication to reduce the risk of forming stones. We may also find that treating an underlying condition that causes renal stone disease is necessary.
Dietary calcium usually should not be severely restricted. Reducing calcium intake often causes problems with other minerals (e.g., oxalate) and may result in a higher risk for calcium stone disease.
To make an appointment in our Pediatric Stone Center, please call us at 215-590-2754. Our office staff will be happy to help you.