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.
- Gearhart JP, Herzberg GZ, Jeffs RD. Childhood urolithiasis: experiences and advances. Pediatrics 1991; 87:445.
- Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc 1993; 68:241.
- Coward RJ, Peters CJ, Duffy PG, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 2003; 88:962.
- VanDervoort K, Wiesen J, Frank R, et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 2007; 177:2300.
- Sternberg K, Greenfield SP, Williot P, Wan J. Pediatric stone disease: an evolving experience. J Urol 2005; 174:1711.
- Pietrow PK, Pope JC 4th, Adams MC, et al. Clinical outcome of pediatric stone disease. J Urol 2002; 167:670.
- Polito C, La Manna A, Signoriello G, Marte A. Recurrent abdominal pain in childhood urolithiasis. Pediatrics 2009; 124:e1088.
- Kalorin CM, Zabinski A, Okpareke I, et al. Pediatric urinary stone disease--does age matter? J Urol 2009; 181:2267.
- Catalano-Pons C, Bargy S, Schlecht D, et al. Sulfadiazine-induced nephrolithiasis in children. Pediatr Nephrol 2004; 19:928.
- Persaud AC, Stevenson MD, McMahon DR, Christopher NC. Pediatric urolithiasis: clinical predictors in the emergency department. Pediatrics 2009; 124:888.
- Nimkin K, Lebowitz RL, Share JC, Teele RL. Urolithiasis in a children's hospital: 1985-1990. Urol Radiol 1992; 14:139.
- Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176:289.
- Colleran GC, Callahan MJ, Paltiel HJ, et al. Imaging in the diagnosis of pediatric urolithiasis. Pediatr Radiol 2017; 47:5.
- Passerotti C, Chow JS, Silva A, et al. Ultrasound versus computerized tomography for evaluating urolithiasis. J Urol 2009; 182:1829.
- Smith SL, Somers JM, Broderick N, Halliday K. The role of the plain radiograph and renal tract ultrasound in the management of children with renal tract calculi. Clin Radiol 2000; 55:708.
- Diament MJ, Malekzadeh M. Ultrasound and the diagnosis of renal and ureteral calculi. J Pediatr 1986; 109:980.
- Palmer JS, Donaher ER, O'Riordan MA, Dell KM. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol 2005; 174:1413.
- Smergel E, Greenberg SB, Crisci KL, Salwen JK. CT urograms in pediatric patients with ureteral calculi: do adult criteria work? Pediatr Radiol 2001; 31:720.
- Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med 2007; 357:2277.
- Donnelly LF, Emery KH, Brody AS, et al. Minimizing radiation dose for pediatric body applications of single-detector helical CT: strategies at a large Children's Hospital. AJR Am J Roentgenol 2001; 176:303.
- Karmazyn B, Frush DP, Applegate KE, et al. CT with a computer-simulated dose reduction technique for detection of pediatric nephroureterolithiasis: comparison of standard and reduced radiation doses. AJR Am J Roentgenol 2009; 192:143.
- Radiation risks and pediatric computed tomography (CT): A guide for health care providers. Available at: www.nci.nih.gov/cancertopics/causes/radiation-risks-pediatric-CT (Accessed on April 29, 2009).
- 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS