Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

Kidney Stone Clinic for children

Kidney stone Clinic for children has been started to disseminate information & knowledge to parents & families having children with kidney stones, treat children with kidney stones and initiate preventive measures to avoid recurrence of stones in the little ones.

Till some years back, children suffering from kidney/ urinary stones, were a rarity and unheard of. With changes in diet & lifestyle, the incidence of kidney stones in children has increased significantly.

  • Children less than 12 years comprise 1% of all population with kidney stones but this is old data. Recent studies have shown increasing incidence of Kidney stones in children worldwide. Studies from USA and Europe have highlighted this too. We are seeing the same in India.
  • Children with Kidney stones should be managed separately from adults as causes, risk factors and management is different. Adult findings cannot be extrapolated to developing kidneys in kids.
  • Upto 50% of the children may have underlying abnormalities leading to formation of kidney stones such as high calcium in urine, low citrate in urine, high uric acid or oxalates in urine.
  • Stone formation occurs when balance between stone forming substances in urine such as calcium, oxalate, phosphate and stone inhibiting substances such as citrate or magnesium gets disturbed.
  • Most common are calcium oxalate stones.
  • There is high rate of recurrence of stones in children if full clearance is not achieved or metabolic evaluation is not performed and managed. Recent Studies have shown increasing incidence of urinary stones in kids. At Pediatric Urology division at MITR Healthcare & MGM Hospital, we see about 7-8 cases of children with kidney stones every month for last 1 year.
  • Apart from underlying abnormalities, dietary factory may also play a role in formation of kidney stones in children. Two important  risk factors for stone formation in kids are-  Not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
  • Poor water intake and periods of dehydration in summer months also precipitate stone formation. Recent research has shown a link between global warming and dehydration. The more dehydrated one becomes, the more concentrated the urine becomes leading to crystal and eventual stone formation. Recent studies in global warming indicate that the number of patients yearly who are treated for kidney stones is going to increase from 1 million to 2 million.
  • Decreasing the salt intake - Limit salty snacks such as chips, junk foods and pretzels, which are loaded with sodium. Look for "no salt added" or "low sodium" labels when buying food. Rinse canned foods under water to remove some of the sodium.
  • Processed foods, including smoked and cured meats, as well as sodas and canned products have the highest sodium content.
  • Tea, coffee, dark chocolate, spinach, nuts and wheat bran can also increase the risk of certain types of kidney stones.  Processed food has preservatives and high salt content.
  • A family history of kidney stones is also a significant risk factor.
  • Childhood obesity is also a risk factor for stone formation.
  • Food adulteration: In China recently, many children who drank milk tainted with melamine- a toxic chemical illegally added to watered-down milk to inflate the protein count - developed kidney stones
  • Provision of adequate drinking water- Doctors recommend for children between the ages of 5 and 10 who have kidney stones to drink six glasses of water a day and those kids over 10, to drink 10 glasses.
  • Decrease or stop colas, high sugar/ salt drinks.
  • A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.
  • Active lifestyle & prevention of obesity: Children today seem to live a lifestyle that puts them at risk of kidney stones, meaning they consume sugar-filled drinks and a fast-food diet that is high in sodium, a known risk factor in the formation of kidney stones. Also, obesity increases the risk of forming kidney stones.
  • Dietary changes (vide supra)
  • Back and/or and abdominal pain.
  • Blood in urine
  • Urinary infections
  • Pain in urination or frequent urination

Parents may often mistake their child's symptoms for appendicitis or gastritis. Kidney stones tend to be way down on the list of possible problems.

  1. Metabolic testing: Recommended in all children diagnosed with kidney stones to find out the cause of kidney stones. If there is any underlying cause then treatment can be given so that the stones do not form again.
  2. Spontaneous passage: If stones are small (less than 5mm), there are high chances if natural passage of stones. Medicines can help in this evacuation.
  3. ESWL (Extracorporeal Shock Wave Lithotripsy): If the stone is small and in a suitable location, shockwave lithotripsy can be used. The procedure occurs under an anesthetic. Sound waves are used to break up the stone into small pieces, which the child can then pass. This is possible only for children more than 3-4 years of age Click Here to see the Case History
  4. URS (Uretero-renoscopy): For the stones which are stuck in the urinary pipe (Ureter)- Uretero-renoscopy can be performed. A small miniaturized telescope is passed through the natural passages into the urinary system and the stones are treated with a laser. With newer & smaller diameter flexible scopes, doctors can even reach the kidney stones with URS.
  5. PCNL/ Mini-perc: In cases where the kidney stone is very large, PCNL or Mini-perc is used. Percutaneous Nephrolithotomy (PCNL or Perc) is a procedure routinely employed for such stones in adults. It entails making a direct puncture into the kidney through the back with a fine needle under radiological guidance. Through the needle a guidewire is then placed and the route to the stone is made gradually bigger to about 1cm by stepwise dilatation. Finally, a telescope called nephroscope is placed and the stone is broken down into small pieces with soundwaves or Laser and removed. Adult instruments are bigger and allow removal of large pieces. Same sized instruments if used in young children can lead to kidney damage and bleeding.

For children a technique called – Mini-perc or Mini PCNL is recently being introduced. The size of the telescope is 12 French (adult is 20/24 Fr) and this can be easily used in small kids. The net cut on the back is less than 5mm and is safe for a developing small kidney. Larger fragments cannot be removed but Holmium Laser comes in handy in breaking these stones into really small pieces which are then removed or washed out

Click Here to see the Case History
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