March 27, 2009

Rising Number Of Children With Kidney Stones

Doctors are scratching their heads to understand an apparent rise in the number of children with kidney stones, typically an adult condition.  Some believe that kids' love of burgers, fries and other salty foods is behind the increase.

The malady causes excruciating pain, worse than childbirth in some cases. And while the number of affected children isn't alarming, an increasing number of kids with kidney stones have been showing up at hospitals throughout the country.

Johns Hopkins Children Center in Baltimore, a referral center for kids with kidney stones, used to treat one or two children annually 15 years ago, but now receives calls for new cases every week, according to kidney specialist Dr. Alicia Neu.

At Children's Hospital of Philadelphia, the number of children treated for kidney stones since 2005 has jumped from roughly 10 per year to five patients a week now, Dr. Pasquale Casale told the Associated Press.

A 2007 study published in the Journal of Urology reported a fivefold increase in the number of children with kidney stones brought in to North Shore-Long Island Jewish Medical Center between 1994 and 2005, with 61 children treated for kidney stones in 2005.

Dr. David Hatch at Loyola University Medical Center in Maywood, IL, told the AP he has also seen an increase.  He said his youngest patient was an irritable 8-month-old baby whose mother had found a pea-size kidney stone in the girl's diaper.

Dr. Uri Alon, director of the bone and mineral disorders clinic at Children's Mercy Hospital in Kansas City, told the AP that children's' stones were a big topic during recent pediatric kidney specialists' conferences.

While evidence is anecdotal, Alon is involved in research seeking to determine whether the increase is real and not just the result of greater awareness and better detection.  

He is also researching whether better nutrition can prevent kidney stones in children.  Consumption of excess salt can result in too much calcium in the urine. Since most stones in children are calcium-based, Alon said eating habits, combined with drinking too little water, can put children at risk. Doctors generally advise drinking plenty of water to help prevent kidney stones.

Eight year old Matty Billemeyer has already has had four bouts with stones since 2007, when he was first stricken during his first-grade class. His parents, the school nurse, and even the emergency room doctors, all initially believed it was his appendix.

"It felt really painful and intense," the Doylestown, Pa., boy told the AP.

"I was really scared because it was hurting a lot."

Darryl Billemeyer was frightened to see his son screaming and writhing in pain.  Matty was transferred from a local hospital to Children's Hospital of Philadelphia, where an ultrasound test revealed kidney stones.

"We really didn't know what to make of it," Billemeyer told the AP.

"I definitely thought they were more of an adult thing."

The first time, Matty needed surgery, while the stones passed during urination the other times.  He now brings a water bottle to school each day,  takes diuretic pills to increase urination and has forgone some of his favorite foods like sausages, pickles and packaged ramen noodles, which all contain high levels of salt.

Matty's parents are both busy teachers.  Their hectic jobs, combined with four other sons, meant family meals often consisted of quick processed foods like chicken nuggets or canned spaghetti.

Before Matty's diagnosis, salt "wasn't something we really thought about," Billemeyer said.

Excruciating pain is the major problem associated with kidney stones, caused by stones blocking the flow of urine.  Left untreated, the stones can lead to kidney damage.

The preferred treatment is observation and providing children with pain medicine alone to see if the stones, which can be as small as a sugar granule or as large as a pearl, will pass on their own.

Most stones are less than a quarter inch in diameter, although larger stones have been reported.  However, even small ones can cause extreme pain.

If a stone does not pass on its own, the patient is anesthetized and doctors may thread a thin scope through the urinary tract to break up and remove the stone. Other treatments include minimally invasive surgery or noninvasive shock-wave therapy using sound waves to break up the stone.

Cedars-Sinai Medical Center pediatric urologist Dr. Barry Duel said kidney stones can be a sign of underlying metabolic problems that can cause too much calcium in the urine.

However, in most cases children do not have any underlying disorder, he told the AP.

Nevertheless, because some metabolic problems can slow growth cause repeated bouts with kidney stones if untreated, the American Academy of Pediatrics advises all children with kidney stones be tested for metabolic problems.

But Hatch maintains the best prevention is plenty of water, so minerals in the urine stay dissolved.  The amount of water children should drink depends on a child's size, but for the average 10-year-old it would be roughly four cups a day, in addition to anything else they drink.  This far exceeds the amount of water most children drink.

"What I like to tell kids is that they should drink enough water to keep their pee almost clear," Hatch told the AP.

For kids who have already had a kidney stone, physicians sometimes advise drinking fresh-squeezed lemonade or other citrus juices, which can help keep the urine from forming stones.


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