Kovacevic L., 2023: Diagnosis and Management of Nephrolithiasis in Children
Kovacevic L.
Department of Pediatric Urology, Michigan State University and Central Michigan University, Stone Clinic, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit 48201, MI, USA.
Abstract
The incidence of kidney stones in children is increasing. Approximately two-thirds of pediatric cases have a predisposing cause. Children with recurrent kidney stones have an increased higher risk of developing chronic kidney. A complete metabolic workup should be performed. Ultrasound examination is the initial imaging modality recommended for all children with suspected nephrolithiasis. A general dietary recommendation includes high fluid consumption, dietary salt restriction, and increased intake of vegetables and fruits. Depending on size and location of the stone, surgical intervention may be necessary. Multidisciplinary management is key to successful treatment and prevention.
Pediatr Clin North Am. 2022 Dec;69(6):1149-1164. doi: 10.1016/j.pcl.2022.07.008. Epub 2022 Oct 29. PMID: 36880927 Review.
Comments 1
There are several recent articles published on the management of children with urinary tract stones. This article is one of them that emphasizes the necessity to consider both medical and surgical aspects. The current interest is related to an increased annual incidence and to the fact that there has been a shift from infection stones to metabolic stones. Accordingly, the author recommends a careful metabolic risk evaluation and the principles are discussed comprehensively in the article. For the need of combined metabolic and surgical care this report is valuable reading for urologists in general. Of particular interest is the table in which normal limits of creatinine-related urinary variables are summarized.
The presented indications for surgical treatment comprise:
Stones with a diameter > 5mm.
Obstructing or infection stones with or without history of sepsis.
Acute kidney injury.
Pain difficult to treat.
SWL is presented as first-line treatment for small (15 mm can be discussed in view of the superior transport capacity of the child’s ureters.
The authors recommend 2-3 weeks of stenting before URS to avoid trauma to the ureter. Otherwise, stenting is less important for children treated with SWL.
It is surprising that struvite stones are considered as less suitable for SWL, a recommendation that is not supported by my own experience. Moreover, cystine stones that have been in the urinary tract for a short period (as in most young children) are usually easier to disintegrate with SWL than such stones in adults and the same might be true for COM.
The bottom-line of the message in this report is, however, that in many centers SWL is and should be the first line intervention - a statement that I fully agree with.
Hans-Göran Tiselius