Q. My child complains burning on & off, while passing urine. Also, he has backache. What to do?

A. Burning while passing urine and backache are symptoms of kidney problems, because kidneys are placed at the posterior abdominal wall on either side of spine. Commonly these symptoms occur due to urinary tract infection and in absence of fever, renal stones should be ruled out.

Q. My child's urine examination showed presence of plenty of crystals. However he has no complaints. What should I do?

A. If urine examination shows plenty of crystals, but the child has no complaints, there is no need to worry. But if there is family history of kidney stones, 24 hours urine excretion of calcium, uric acid, oxalate etc may be done to detect hypercalciuria, hyperuricosuria, hyperoxaluria, which are precursors of stone formation.

Q. What are urinary stones? I thought stones were seen in adults. Does it occur in children?

A. Stones are formed when substances such as calcium, phosphate, uric acid, oxalate are in excess in urine, become insoluble and form concretions and settle on a matrix in tubules. Urinary infections can increase the size of these concretions and further harden them. Although stones are common in adults, they can occur in children.

Q. How do these urinary stones occur?

A. Stones occur due to abnormal and excessive accumulation of stone forming substances in urine which are normally dissolved due to presence of substances which inhibit stones formation like citrate, pyrophosphates. If the concentration of calcium, oxalate, uric acid, cystine etc is very high and inhibitors are low, stone formation occurs. The abnormal metabolic disorders can be inherited e.g. Hypercalciuria, hyperoxaluria, cystinuria. Less intake of fluids, urinary infection, congenital anomalies of urinary tract with obstruction, hyperparathyroidism, RTA (renal tubular acidosis) are causes of renal calculi or stones.

Q. How do I know whether my child is suffering from kidney stones?

A. Kidney stones can give rise to abdominal pain, hematuria (blood in urine), vomiting, backache, recurrent urinary tract infections or are accidentally discovered on USG (Ultrasonography).

Q. How does one diagnose presence of renal stones?

A. Diagnosis is made by plain X-RAY of kidneys, ureters and urinary bladder or ultrasonography.

Q. My child's X-rays showed no stones. However, the doctor says that he is suffering from kidney stones. Is it possible?

A. Some kidney stones are radiolucent i.e. cannot be seen on plain x-rays but can be diagnosed by Ultrasonography e.g. uric acid, cystine stones.

Q. Is USG a must to do in a patients with kidney stones ?

A. If a high degree of suspicion exists and plain X-rays do not show stones, USG is a must for diagnosis.Small stones pass out with high fluid intake, citrate treatment, alkali administration etc.

Q. My child has a renal stone, However he has no complaints. Does he still have to get treated? Can't we just leave him alone ?

A. If the kidney stone (s) is small and is causing ho complaints there is no need to treat. Periodic imaging(USG) is required to assess the size and whether it has moved from its location. However, a larger stone requires treatment as it may later cause complications like colic, renal damage etc.

Q. What are the complications of urinary stones ?

A. Complications of urinary stones are urinary infection and obstruction which may lead to destruction of renal parenchyma and if the stones are on both the sides, they may cause obstruction and destruction of both kidneys. In the long run, chronic renal failure (CRF) can occur.

Q. Are kidney stones recurrent? How can I prevent it from occurring again ?

A. Kidney stones can be recurrent. To prevent recurrence, it is advisable to drink large quantities of water, which does not allow accumulation of concretions. Use of inhibitors like citrate solution may help.