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Q. Most of the members of our family had stones some point in life. Is there something like a family history of stones? How is stone formation prevented?

A. Family history of renal stones helps in early diagnosis of certain metabolic disorders which are precursors for stone formation e.g. hypercalciuria which can be detected by 24 hours urine excretion of calcium. More than 4mg/kg/day calcium excretion is abnormal. Advise regarding high fluid intake helps in prevention.

Certain areas are known for increased prevalence for renal calcium or urolithiasis because of hot climate, excess of calcium/ manganese/ aluminium and many other minerals in soil/ water which increase the solute load. People living in these areas including children suffer from increased incidence of stones. In India, Rajasthan, Kutch and certain areas of Gujarat, Punjab are known as stone belts.

Q. What is the treatment for kidney stones?

A. Depending on size, location, whether stone is causing obstruction, stone can be removed by ESWL (Lithotripsy), percutaneous nephrolithotomy (PCNL), cystoscopy (removal of the stone though the bladder with the help of an instrument called as an endoscope) or surgical removal. The modality of treatment depends on expertise of the surgeon and how much the patient can afford.

Q. What is ESWL? Can be done in a child? What are its indications?

A. ESWL (Extracorporeal shock wave lithotripsy) is a recent advance in treatment of stones. This is done by a special equipment, which is very expensive and is based on bombarding the stone with high frequency shocks. The pulverized stone is than passed in urine as small pieces. More than one sitting may be needed for removal of single stone. Each sitting costs approximately Rs 5000-6000. In very small infants and children below 5 years of age, it is not advised. Very small (less than 2cm) and very large (more than 8cm) stones can not be treated by ESWL. Calcium oxalate, Struvite and uric acid stones are easy to fragment. Cystine stone are difficult to treat with ESWL.

Q. Does alkalinizing the urine help in dissolving the stone? When should it be done?

A. Alkali treatment is useful to dissolve crystals before stone formation occurs. Citrate alkali therapy is useful to dissolve uric acid or calcium oxalate crystals, for prevention of recurrence of stones and should be started no sooner the diagnosis is made. Dissolution of a stone may not be possible.

Q. My child had sudden onset of pain, which he felt from the loin to his penis. What to do?

A. When pain starts suddenly from loin to penis, it means that the stone has moved and is trying to come out. At this time pain reliever and antispasmodic medication is advised namely Ibuprofen and Dicyclomine. Fresh Ultrasonography/ X-rays are needed to localize the stone. Child may require hospitalization if pain is severe till the stone is passed. IV fluids, IV NaHCO3 with furosemide can push the stone out.

Q. Can modification in diet help to decrease formation of renal stones?

A. Depending on the composition of the stone, diet should be modified e.g. uric acid stones due to high serum uric acid should be treated with restriction of meat, dals and pulses; oxalate stones require restriction of spinach and tomatoes which are rich in oxalates.

For further details see "Diet for renal Stones"

Q. In a child with calcium stones, should milk be omitted from the diet?

A. In growing children, restriction of milk or dairy product to reduce calcium in diet is not advisable because calcium and high class milk proteins are required for growth and mineralisation of bones. Tonics containing excess of calcium should be avoided.

Q. How is a child with renal stones to be monitored?

A. Child with renal stones should be monitored regularly for symptoms like pain, hematuria, urinary complaints like dysuria (pain while passing urine), frequency, burning etc. Ultrasonography should be done every 2-3 months to look at the progress of stone. Urine is examined for hematuria (blood in urine), pyuria (pus in urine) and if required urine culture for UTI should be done till the stone is passed or removed.

Q. What is the prognosis of a child with renal stones?

A. Prognosis is good if the stone is single and isolated. But recurrent stones, which obstruct the urinary passage and are associated with recurrent calculi and recurrent UTI can progress to CRF.

Last created on 04-04-2001
Last updated on 01-07-2006