Acute management of nephrolithiasis in children
- Thomas S Lendvay, MD, FACS
Thomas S Lendvay, MD, FACS
- Associate Professor, Department of Urology
- University of Washington
- Jodi Smith, MD, MPH
Jodi Smith, MD, MPH
- Associate Professor of Pediatrics
- University of Washington
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
The management of pediatric nephrolithiasis is divided into two parts.
●Acute episode – During the acute phase when the stone is being passed, management is directed towards pain control, and facilitating passage or removal of the stone(s).
●Prevention of recurrent disease – After the acute episode, management is directed towards prevention of recurrent stone disease. This includes an evaluation to identify any underlying cause or risk factors for stone formation. Based upon this assessment, interventions are tailored to reduce the risk of recurrent stone formation.
The acute management of childhood nephrolithiasis will be reviewed here. The prevention of recurrent disease, epidemiology, risk factors, clinical manifestations, and diagnosis of nephrolithiasis in children are discussed separately. (See "Prevention of recurrent nephrolithiasis in children" and "Epidemiology of and risk factors for nephrolithiasis in children" and "Clinical features and diagnosis of nephrolithiasis in children".)
The acute management of nephrolithiasis depends upon the severity of the pain, and the presence of obstruction or infection. In some patients, outpatient medical management with oral analgesics and hydration is possible. However, in others, especially those with nausea, vomiting, and severe pain, hospitalization is required for parenteral fluid and pain medication. Other indications for hospitalization include urinary obstruction, solitary kidney, and infection.
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- MEDICAL MANAGEMENT
- Supportive care
- - Pain control
- Urine culture
- Stone passage
- Stone retrieval
- UROLOGIC INTERVENTION
- - Extracorporeal shock wave lithotripsy
- Renal growth
- - Percutaneous nephrostolithotomy
- - Ureteroscopy
- - Stenting
- Choice of procedure
- - Recommended approach
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS