Predominant Calcium Stone - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Childhood Ailments

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Question
I adopted my daughter in March of 2000 from China. When we received her she had a runny nose and was running a temperature. She barely urinated for days and of course her urine was very dark and concentrated. She ran temps of 105F. On return to the U.S. she was diagnosed with Hepatitis B. She is a carrier and she has labs drawn yearly. She drinks fair amount of liquids, mostly juice or pop, some water and milk daily. She is now 2 1/2. About 1 month ago, she started running a fever and vomiting. She continued to run a low grade fever for 2 days but the vomiting didn't persist. On that third days she was in a squatting position and was screaming and crying. I asked her what is wrong and she kept saying pee peed. I thought she was constipated due to low intake of fluids and fever. She insisted it was pee. She finally settled down and I asked her if she wanted to take a bath. I thought it would not only help her temperature come down but I thought it would help relax her. When I took off her diaper, her urine was slightly on the orangy side but I was surprised to find a stone like object in her diaper. I am a nurse, and my first reaction was kidney stone but I discarded the idea not only because of her age (2 1/2) but also the sheer size of the stone. Her pediatrician suggested we go into the ER because she may have an urinary tract infection. We weren't able to get a UA on her but I found out today that it was a Calcium stone. I can't recall what kind at this time. After reviewing your website information on diet causing calcium stones I think it is highly unlikely that her diet has caused this. Although I didn't see where pop is listed as a contributing factor. With the limited information I have given you, what is your wildest guess as to what is causing a kidney stone in Kaylena? Do you suspect hyperparathyroidism?
Answer
Kidney stones in children are though rare but not unusual. Your child has had symptoms of urinary problems even at the time of adoption when she barely passed urine and had concentrated urine. The causes of stones in a child are plenty. Since, your child had a predominant calcium stone, the causes that you would want to rule out would be hypercalciuria (increased calcium excretion in the urine), oxaluria (increased oxalate excretion in the urine), nephrocalcinosis (increased calcium deposit in the kidney most commonly due to renal tubular acidosis), hyperparathyroidism and other metabolic defects. Your child needs to be investigated for the same. Along with ultrasound of the kidneys to rule out more stones and nephrocalcinosis, urine examination with 24 hours urine excretion of calcium, oxalate and uric acid may be required to come to the correct diagnosis. Consult a good pediatric nephrologist for the same. Back to All Questions

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