Kidney Stones

“Is
it hurting where I’m touching?” asks Dr. Kathleen Nelson,
professor of pediatrics. “Right there it does,” cringes
fourteen-year-old Bradley Entrekin. He has a kidney stone.

“And do you actually feel the pain in one spot or does
it go…” asks Dr. Nelson. “Just in my back going
all the way down,” replies Bradley. He is in a lot of pain,
and this isn’t the first time. “So it’s bad enough
that you were doubled over and it, it didn’t get better?
And you’ve had this kind of pain before?” she asks. “Four
times. This is the fourth time,” explains Bradley.

His CT scan shows that this stone is only the size of two grains
of sand. “It’s amazing how something so little could
cause so much pain,” says the doctor. “I don’t
see how it does,” Bradley says. “Well, what happens
is it causes a little spasm in the tube that leads from the kidney
down into the bladder. And it’s really the spasm that’s
causing you the pain,” the doctor explains.

But what could be causing the stones? “Probably the most
common reason why kids have stones, though, has to do with not
drinking enough,” Dr. Nelson explains. “Do you drink?” she
asks Bradley. “I try to, but it’s kind of hard at school
cause they don’t let me carry a water bottle around,” he
says.

A urine test is done to make sure there is no infection. “And
as we would suspect, this is loaded with blood, and there’s
no sign of infection,” states Dr. Nelson.

Bradley will be sent home in hopes of passing the stone on his
own. When he returns to school, he will have a doctor’s prescription
allowing him to carry water with him to class. The doctor’s
advice- “Drink more liquid. Drink. Drink. Drink.”

Kidney stones are much more rare in children than in adults. Experts at Johns
Hopkins Medical Institutions say children get kidney stones about 1 percent
as often as adults – it is estimated that adults have a one-in-10 lifetime
chance of developing serious kidney stones. Adults are more likely to pass
their stones with only medical management for pain. Children are more likely
to have their stones removed.

According to pediatric urologist Dr. Steven G. Docimo, “Odds
are that the stones will eventually cause trouble, growing to obstruct
the kidney.”

Some stones can be treated with extra corporeal shock wave lithotipsy.
But the more “resistant” kidney stones may have to be
surgically removed.

Kidney stones have plagued mankind for thousands of years. Scientists
have even found traces of kidney stones in mummies more than 7,000
years old. Today, more than 1 million cases are reported each year
in the United States, mostly in adults.

Kidney stones sometimes occur when urine becomes too concentrated.
This causes minerals and other substances in the urine to form crystals
on the inner surface of the kidneys. Eventually, these crystals may
combine to form a small, hard, stone-like mass. Sometimes this mass,
or stone, breaks off and passes into the ureter (one of the two thin
tubes that leads from the kidney to the bladder). If the stone blocks
the ureter, pain occurs.

Not all kidney stones cause symptoms. According to the Mayo Clinic,
it’s not unusual for stones to be discovered in the kidneys during X-rays
for an unrelated problem. If the kidney stone becomes large or causes a blockage
or an infection, your child may experience “intense, colicky pain” that
fluctuates in intensity over a period of five to 15 minutes. The pain starts
in the back or side just below the edge of the ribs. As the stone moves toward
the bladder, the pain may radiate down toward the groin. If the stone stops
moving, the pain may stop, too. Other symptoms may include the following:

• Bloody, cloudy or foul-smelling urine
• Nausea and vomiting
• Persistent urge to urinate
• Fever and chills if an infection is present

In children, kidney stones are frequently linked with what Dr. Docimo
calls “an underlying anatomical abnormality,” such as spina
bifida, a reconstructed urinary tract or augmented bladder. The Mayo
Clinic also lists the following “risk factors” that may
increase the chances of developing kidney stones:

• Family or personal history: If someone in your family
  has kidney stones, you’re more likely to develop these stones,
  too.
• Age, gender and race: Most people who develop kidney stones
  are between 20 and 40 years of age. Men are more likely to develop
  kidney stones than women are, although for unknown reasons the number
  of women with kidney stones is increasing.
• Certain diseases: Rare, inherited diseases, such as renal
  tubular acidosis and cystinuria, can increase the risk of kidney
  stones.
• Certain medications: Taking certain types of water pills
  (diuretics), some thyroid medications or calcium-based antacids (Tums,
  Alka-Seltzer, Rolaids) may increase your risk of forming kidney stones.
  On the other hand, thiazide diuretics may help lessen the chance
  of stone formation.
• A single kidney: Although most people have two kidneys,
  approximately one in every 1,500 babies is born with only one kidney.
  Many people live full healthy lives with a single kidney, but they
  do have an increased risk of kidney stones.
• Diet: A diet that’s high in protein (meat, chicken,
  fish, etc.) and low in fiber (fruits, vegetables and whole grains)
  may increase your risk of some types of kidney stones.
• A lack of fluids: If you don’t drink enough fluids,
  especially water, your urine is likely to have higher concentrations
  of substances that form stones.
• Limited activity: You’re more prone to develop kidney
  stones if you’re bedridden or very sedentary for a period of
  time. That’s because limited activity can cause your bones
  to release more calcium.

The best way to prevent kidney stones is to drink lots of water so the
stones get washed out of the body before they become large.

Johns Hopkins Medical Institutions
Mayo Clinic