Clinical features and diagnosis of nephrolithiasis in children
- 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
Nephrolithiasis is increasingly recognized in children. Its presentation varies, and often patients, especially young children, do not present with the classic acute onset of flank pain commonly seen in adults. As a result, children are frequently evaluated for other conditions before the diagnosis of nephrolithiasis is made. The clinical features and diagnosis of childhood nephrolithiasis will be reviewed here. The epidemiology, risk factors, acute management, and prevention of recurrent nephrolithiasis in children are discussed separately. (See "Epidemiology of and risk factors for nephrolithiasis in children" and "Acute management of nephrolithiasis in children" and "Prevention of recurrent nephrolithiasis in children".)
Most children with nephrolithiasis present symptomatically, usually with flank or abdominal pain. Approximately 15 to 20 percent are asymptomatic, primarily young children who are diagnosed because of stone detection when abdominal imaging is performed for other purposes [1-3].
In those with symptomatic presentation, the most common symptom is pain [1-4]. Other potential manifestations include gross hematuria, dysuria and urgency, and nausea/vomiting.
Pain — Pain can be located either as abdominal or flank pain (referred to as renal colic). In several case series, pain was the presenting complaint in 50 to 75 percent of patients [1-5].
Pain frequency varies with age. In one report, for example, pain was present in 60, 40, and 20 percent of adolescents, school-aged children, and children below five years of age, respectively . The age-related difference in pain may be related to stone location at presentation. Younger children (ie, less than five years of age) are much less likely to have ureteral stones than school-aged children and adolescents (32 versus 64 and 82 percent, respectively) . Ureteral stones are generally painful, since they cause ureteral obstruction, whereas kidney stones are often asymptomatic and may be diagnosed as an incidental finding on abdominal imaging.
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- CLINICAL PRESENTATION
- Gross hematuria
- Dysuria and urgency
- Young children
- INITIAL EVALUATION
- Physical examination
- Laboratory evaluation
- - Ultrasonography
- - Non-contrast helical CT
- - Abdominal plain radiography
- - Our approach
- DIFFERENTIAL DIAGNOSIS
- Abdominal or flank pain
- Gross hematuria
- Urinary tract infection
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS