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.
- Pietrow PK, Pope JC 4th, Adams MC, et al. Clinical outcome of pediatric stone disease. J Urol 2002; 167:670.
- Kalorin CM, Zabinski A, Okpareke I, et al. Pediatric urinary stone disease--does age matter? J Urol 2009; 181:2267.
- Aydogdu O, Burgu B, Gucuk A, et al. Effectiveness of doxazosin in treatment of distal ureteral stones in children. J Urol 2009; 182:2880.
- Erturhan S, Bayrak O, Sarica K, et al. Efficacy of medical expulsive treatment with doxazosin in pediatric patients. Urology 2013; 81:640.
- Mokhless I, Zahran AR, Youssif M, Fahmy A. Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study. J Pediatr Urol 2012; 8:544.
- Tasian GE, Cost NG, Granberg CF, et al. Tamsulosin and spontaneous passage of ureteral stones in children: a multi-institutional cohort study. J Urol 2014; 192:506.
- Parvex P, Pippi-Salle JL, Goodyer PR. Rapid loss of renal parenchyma after acute obstruction. Pediatr Nephrol 2001; 16:1076.
- Paryani JP, Ather MH. Improvement in serum creatinine following definite treatment of urolithiasis in patients with concurrent renal insufficiency. Scand J Urol Nephrol 2002; 36:134.
- Gupta M, Bolton DM, Gupta PN, Stoller ML. Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol 1994; 152:1086.
- Silverman DE, Stamey TA. Management of infection stones: the Stanford experience. Medicine (Baltimore) 1983; 62:44.
- Yoshimura K, Utsunomiya N, Ichioka K, et al. Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 2005; 173:458.
- Muslumanoglu AY, Tefekli A, Sarilar O, et al. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol 2003; 170:2405.
- Shukla AR, Hoover DL, Homsy YL, et al. Urolithiasis in the low birth weight infant: the role and efficacy of extracorporeal shock wave lithotripsy. J Urol 2001; 165:2320.
- Shokeir AA, Sheir KZ, El-Nahas AR, et al. Treatment of renal stones in children: a comparison between percutaneous nephrolithotomy and shock wave lithotripsy. J Urol 2006; 176:706.
- Thomas JC, DeMarco RT, Donohoe JM, et al. Pediatric ureteroscopic stone management. J Urol 2005; 174:1072.
- Durkee CT, Balcom A. Surgical management of urolithiasis. Pediatr Clin North Am 2006; 53:465.
- Shouman AM, Ziada AM, Ghoneim IA, Morsi HA. Extracorporeal shock wave lithotripsy monotherapy for renal stones >25 mm in children. Urology 2009; 74:109.
- Rodrigues Netto N Jr, Longo JA, Ikonomidis JA, Rodrigues Netto M. Extracorporeal shock wave lithotripsy in children. J Urol 2002; 167:2164.
- Goel MC, Baserge NS, Babu RV, et al. Pediatric kidney: functional outcome after extracorporeal shock wave lithotripsy. J Urol 1996; 155:2044.
- McLorie GA, Pugach J, Pode D, et al. Safety and efficacy of extracorporeal shock wave lithotripsy in infants. Can J Urol 2003; 10:2051.
- Gofrit ON, Pode D, Meretyk S, et al. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.? J Urol 2001; 166:1862.
- Landau EH, Shenfeld OZ, Pode D, et al. Extracorporeal shock wave lithotripsy in prepubertal children: 22-year experience at a single institution with a single lithotriptor. J Urol 2009; 182:1835.
- Salem HK, Fathy H, Elfayoumy H, et al. Slow vs rapid delivery rate shock wave lithotripsy for pediatric renal urolithiasis: a prospective randomized study. J Urol 2014; 191:1370.
- Onal B, Tansu N, Demirkesen O, et al. Nomogram and scoring system for predicting stone-free status after extracorporeal shock wave lithotripsy in children with urolithiasis. BJU Int 2013; 111:344.
- Afshar K, McLorie G, Papanikolaou F, et al. Outcome of small residual stone fragments following shock wave lithotripsy in children. J Urol 2004; 172:1600.
- Yucel S, Akin Y, Danisman A, Guntekin E. Complications and associated factors of pediatric extracorporeal shock wave lithotripsy. J Urol 2012; 187:1812.
- Griffin SJ, Margaryan M, Archambaud F, et al. Safety of shock wave lithotripsy for treatment of pediatric urolithiasis: 20-year experience. J Urol 2010; 183:2332.
- Fayad A, El-Sheikh MG, Abdelmohsen M, Abdelraouf H. Evaluation of renal function in children undergoing extracorporeal shock wave lithotripsy. J Urol 2010; 184:1111.
- Reisiger K, Vardi I, Yan Y, et al. Pediatric nephrolithiasis: does treatment affect renal growth? Urology 2007; 69:1190.
- Fayad A, El-Sheikh MG, El-Fayoumy H, et al. Effect of extracorporeal shock wave lithotripsy on kidney growth in children. J Urol 2012; 188:928.
- Jackman SV, Hedican SP, Peters CA, Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 1998; 52:697.
- Bilen CY, Koçak B, Kitirci G, et al. Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol 2007; 177:1867.
- Dawaba MS, Shokeir AA, Hafez A, et al. Percutaneous nephrolithotomy in children: early and late anatomical and functional results. J Urol 2004; 172:1078.
- Ishii H, Griffin S, Somani BK. Ureteroscopy for stone disease in the paediatric population: a systematic review. BJU Int 2015; 115:867.
- Dangle PP, Bandari J, Lyon TD, et al. Outcomes of Ureteroscopic Management of Pediatric Urolithiasis: A Comparative Analysis of Prepubertal and Adolescent Patients. Urology 2016; 89:103.
- Dave S, Khoury AE, Braga L, Farhat WA. Single-institutional study on role of ureteroscopy and retrograde intrarenal surgery in treatment of pediatric renal calculi. Urology 2008; 72:1018.
- Tan MO, Kirac M, Onaran M, et al. Factors affecting the success rate of extracorporeal shock wave lithotripsy for renal calculi in children. Urol Res 2006; 34:215.
- Demirkesen O, Onal B, Tansu N, et al. Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal stones in children compared with stones in other renal locations. Urology 2006; 67:170.
- Slavković A, Radovanović M, Sirić Z, et al. Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications. Int Urol Nephrol 2002-2003; 34:457.
- Al-Busaidy SS, Prem AR, Medhat M. Pediatric staghorn calculi: the role of extracorporeal shock wave lithotripsy monotherapy with special reference to ureteral stenting. J Urol 2003; 169:629.
- 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS