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Epidemiology of and risk factors for nephrolithiasis in children

Jodi Smith, MD, MPH
F Bruder Stapleton, MD
Section Editor
Laurence S Baskin, MD, FAAP
Deputy Editor
Melanie S Kim, MD


Nephrolithiasis is increasingly recognized in children. The epidemiology and etiology of nephrolithiasis in children will be reviewed here. The clinical manifestations, diagnosis, acute management, and prevention of recurrence are discussed separately. (See "Clinical features and diagnosis of nephrolithiasis in children" and "Acute management of nephrolithiasis in children" and "Prevention of recurrent nephrolithiasis in children".)


The diagnosis of pediatric nephrolithiasis has increased over the past 25 years. This was illustrated in a population-based study of children who were younger than 18 years of age from a single county in Minnesota that reported a yearly increase in the incidence of nephrolithiasis over a 25-year period from 1984 to 2008 [1]. The age-gender adjusted pediatric nephrolithiasis rate rose from 7.2 to 14.5 per 100,000 person-years between the two time periods of 1984 to 1990 and 2003 to 2008. In this study, it remains uncertain whether there was a true increase in the risk of pediatric nephrolithiasis or if there was improvement in making the diagnosis of stone disease with the use of computerized tomography.

In a study analyzing Pediatric Health Information System (PHIS) data from 41 freestanding United States (US) pediatric hospitals from 2002 to 2007, the diagnosis of nephrolithiasis was made in one case for every 685 pediatric hospitalizations [2].

Another report based on the PHIS data demonstrated that the proportion of hospitalizations due to pediatric nephrolithiasis rose from 18.4 per 100,000 admissions in 1999 to 57 per 100,000 in 2008 [3]. This trend is similar to the increased incidence in adult nephrolithiasis, which is thought to be due to changes in dietary habits (eg, increased intake of animal protein and sodium) and increased prevalence of obesity.

Age — The incidence of nephrolithiasis is lower in children than in adults. As an example, in a population-based study from the US of patients over 10 years of age, adolescents between 10 and 19 years of age accounted for only 4 percent of the total episodes of nephrolithiasis [4]. For the total population, the incidence of nephrolithiasis was 109 per 100,000 men per year and 36 per 100,000 women per year. The explanation for the lower pediatric incidence is unknown, but may be due in part to the higher concentrations of crystal formation inhibitors such as citrate and magnesium in the urine of children compared with adults [5,6].


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Literature review current through: Sep 2016. | This topic last updated: Jun 9, 2015.
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  1. Dwyer ME, Krambeck AE, Bergstralh EJ, et al. Temporal trends in incidence of kidney stones among children: a 25-year population based study. J Urol 2012; 188:247.
  2. Bush NC, Xu L, Brown BJ, et al. Hospitalizations for pediatric stone disease in United States, 2002-2007. J Urol 2010; 183:1151.
  3. Routh JC, Graham DA, Nelson CP. Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals. J Urol 2010; 184:1100.
  4. Johnson CM, Wilson DM, O'Fallon WM, et al. Renal stone epidemiology: a 25-year study in Rochester, Minnesota. Kidney Int 1979; 16:624.
  5. Miyake O, Yoshimura K, Tsujihata M, et al. Possible causes for the low prevalence of pediatric urolithiasis. Urology 1999; 53:1229.
  6. Miyake O, Yoshimura K, Yoshioka T, et al. High urinary excretion level of citrate and magnesium in children: potential etiology for the reduced incidence of pediatric urolithiasis. Urol Res 1998; 26:209.
  7. Coward RJ, Peters CJ, Duffy PG, et al. Epidemiology of paediatric renal stone disease in the UK. Arch Dis Child 2003; 88:962.
  8. Gearhart JP, Herzberg GZ, Jeffs RD. Childhood urolithiasis: experiences and advances. Pediatrics 1991; 87:445.
  9. Diamond DA. Clinical patterns of paediatric urolithiasis. Br J Urol 1991; 68:195.
  10. Perrone HC, dos Santos DR, Santos MV, et al. Urolithiasis in childhood: metabolic evaluation. Pediatr Nephrol 1992; 6:54.
  11. Sarkissian A, Babloyan A, Arikyants N, et al. Pediatric urolithiasis in Armenia: a study of 198 patients observed from 1991 to 1999. Pediatr Nephrol 2001; 16:728.
  12. Huang WY, Chen YF, Chen SC, et al. Pediatric urolithiasis in Taiwan: a nationwide study, 1997-2006. Urology 2012; 79:1355.
  13. Novak TE, Lakshmanan Y, Trock BJ, et al. Sex prevalence of pediatric kidney stone disease in the United States: an epidemiologic investigation. Urology 2009; 74:104.
  14. Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc 1993; 68:241.
  15. Stapleton FB, McKay CP, Noe HN. Urolithiasis in children: the role of hypercalciuria. Pediatr Ann 1987; 16:980.
  16. Stapleton FB. Nephrolithiasis in children. Pediatr Rev 1989; 11:21.
  17. Kalorin CM, Zabinski A, Okpareke I, et al. Pediatric urinary stone disease--does age matter? J Urol 2009; 181:2267.
  18. Penido MG, Srivastava T, Alon US. Pediatric primary urolithiasis: 12-year experience at a Midwestern Children's Hospital. J Urol 2013; 189:1493.
  19. DeFoor W, Minevich E, Jackson E, et al. Urinary metabolic evaluations in solitary and recurrent stone forming children. J Urol 2008; 179:2369.
  20. Bergsland KJ, Coe FL, White MD, et al. Urine risk factors in children with calcium kidney stones and their siblings. Kidney Int 2012; 81:1140.
  21. De Santo NG, Di Iorio B, Capasso G, et al. Population based data on urinary excretion of calcium, magnesium, oxalate, phosphate and uric acid in children from Cimitile (southern Italy). Pediatr Nephrol 1992; 6:149.
  22. Kruse K, Kracht U, Kruse U. Reference values for urinary calcium excretion and screening for hypercalciuria in children and adolescents. Eur J Pediatr 1984; 143:25.
  23. Chen YH, Lee AJ, Chen CH, et al. Urinary mineral excretion among normal Taiwanese children. Pediatr Nephrol 1994; 8:36.
  24. Karlén J, Aperia A, Zetterström R. Renal excretion of calcium and phosphate in preterm and term infants. J Pediatr 1985; 106:814.
  25. Sargent JD, Stukel TA, Kresel J, Klein RZ. Normal values for random urinary calcium to creatinine ratios in infancy. J Pediatr 1993; 123:393.
  26. Koyun M, Güven AG, Filiz S, et al. Screening for hypercalciuria in schoolchildren: what should be the criteria for diagnosis? Pediatr Nephrol 2007; 22:1297.
  27. Stapleton FB. Idiopathic hypercalciuria: association with isolated hematuria and risk for urolithiasis in children. The Southwest Pediatric Nephrology Study Group. Kidney Int 1990; 37:807.
  28. Stapleton FB. Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach. Pediatr Nephrol 1994; 8:756.
  29. Garcia CD, Miller LA, Stapleton FB. Natural history of hematuria associated with hypercalciuria in children. Am J Dis Child 1991; 145:1204.
  30. Aladjem M, Barr J, Lahat E, Bistritzer T. Renal and absorptive hypercalciuria: a metabolic disturbance with varying and interchanging modes of expression. Pediatrics 1996; 97:216.
  31. Coe FL, Bushinsky DA. Pathophysiology of hypercalciuria. Am J Physiol 1984; 247:F1.
  32. Pak CY. Physiological basis for absorptive and renal hypercalciurias. Am J Physiol 1979; 237:F415.
  33. Weisinger JR. New insights into the pathogenesis of idiopathic hypercalciuria: the role of bone. Kidney Int 1996; 49:1507.
  34. Srivastava T, Alon US. Pathophysiology of hypercalciuria in children. Pediatr Nephrol 2007; 22:1659.
  35. Moe OW, Bonny O. Genetic hypercalciuria. J Am Soc Nephrol 2005; 16:729.
  36. Gambaro G, Vezzoli G, Casari G, et al. Genetics of hypercalciuria and calcium nephrolithiasis: from the rare monogenic to the common polygenic forms. Am J Kidney Dis 2004; 44:963.
  37. Kollars J, Zarroug AE, van Heerden J, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005; 115:974.
  38. Bergstrom WH. Hypercalciuria and hypercalcemia complicating immobilization. Am J Dis Child 1978; 132:553.
  39. Morgenstern BZ, Milliner DS, Murphy ME, et al. Urinary oxalate and glycolate excretion patterns in the first year of life: a longitudinal study. J Pediatr 1993; 123:248.
  40. Barratt TM, Kasidas GP, Murdoch I, Rose GA. Urinary oxalate and glycolate excretion and plasma oxalate concentration. Arch Dis Child 1991; 66:501.
  41. von Schnakenburg C, Byrd DJ, Latta K, et al. Determination of oxalate excretion in spot urines of healthy children by ion chromatography. Eur J Clin Chem Clin Biochem 1994; 32:27.
  42. Hueppelshaeuser R, von Unruh GE, Habbig S, et al. Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn's disease. Pediatr Nephrol 2012; 27:1103.
  43. Singh A, Sarkar SR, Gaber LW, Perazella MA. Acute oxalate nephropathy associated with orlistat, a gastrointestinal lipase inhibitor. Am J Kidney Dis 2007; 49:153.
  44. Miller LA, Stapleton FB. Urinary citrate excretion in children with hypercalciuria. J Pediatr 1985; 107:263.
  45. Tekin A, Tekgul S, Atsu N, et al. A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk factor. J Urol 2000; 164:162.
  46. Schärer K, Manz F. Renal handling of citrate in children with various kidney disorders. Int J Pediatr Nephrol 1985; 6:79.
  47. Welch BJ, Graybeal D, Moe OW, et al. Biochemical and stone-risk profiles with topiramate treatment. Am J Kidney Dis 2006; 48:555.
  48. Melnick RL, Boorman GA, Haseman JK, et al. Urolithiasis and bladder carcinogenicity of melamine in rodents. Toxicol Appl Pharmacol 1984; 72:292.
  49. Ogasawara H, Imaida K, Ishiwata H, et al. Urinary bladder carcinogenesis induced by melamine in F344 male rats: correlation between carcinogenicity and urolith formation. Carcinogenesis 1995; 16:2773.
  50. World Health Organization. Melamine and cyanuric acid: Toxicity, preliminary risk assessment and guidance on levels in food. September 25, 2008. Available at: www.who.int/foodsafety/fs_management/Melamine.pdf (Accessed on January 27, 2009).
  51. Parry J. China's tainted milk scandal spreads around world. BMJ 2008; 337:a1890.
  52. Sun Q, Shen Y, Sun N, et al. Diagnosis, treatment and follow-up of 25 patients with melamine-induced kidney stones complicated by acute obstructive renal failure in Beijing Children's Hospital. Eur J Pediatr 2010; 169:483.
  53. Guan N, Fan Q, Ding J, et al. Melamine-contaminated powdered formula and urolithiasis in young children. N Engl J Med 2009; 360:1067.
  54. Zhu SL, Li JH, Chen L, et al. Conservative management of pediatric nephrolithiasis caused by melamine-contaminated milk powder. Pediatrics 2009; 123:e1099.
  55. Lam HS, Ng PC, Chu WC, et al. Renal screening in children after exposure to low dose melamine in Hong Kong: cross sectional study. BMJ 2008; 337:a2991.
  56. Panfeng S, Hong C, Zhongjin Y, et al. Management of pediatric urolithiasis induced by melamine-contaminated powdered formula (report of 619 cases). Urology 2011; 78:411.
  57. Jia J, Shen X, Wang L, et al. Extracorporeal shock wave lithotripsy is effective in treating single melamine induced urolithiasis in infants and young children. J Urol 2013; 189:1498.
  58. Wu CF, Hsieh TJ, Chen BH, et al. A crossover study of noodle soup consumption in melamine bowls and total melamine excretion in urine. JAMA Intern Med 2013; 173:317.
  59. Kielb S, Koo HP, Bloom DA, Faerber GJ. Nephrolithiasis associated with the ketogenic diet. J Urol 2000; 164:464.
  60. Herzberg GZ, Fivush BA, Kinsman SL, Gearhart JP. Urolithiasis associated with the ketogenic diet. J Pediatr 1990; 117:743.
  61. Furth SL, Casey JC, Pyzik PL, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatr Nephrol 2000; 15:125.
  62. Sharma S, Gulati S, Kalra V, et al. Seizure control and biochemical profile on the ketogenic diet in young children with refractory epilepsy--Indian experience. Seizure 2009; 18:446.
  63. Hoppe B, Hesse A, Brömme S, et al. Urinary excretion substances in patients with cystic fibrosis: risk of urolithiasis? Pediatr Nephrol 1998; 12:275.
  64. Böhles H, Gebhardt B, Beeg T, et al. Antibiotic treatment-induced tubular dysfunction as a risk factor for renal stone formation in cystic fibrosis. J Pediatr 2002; 140:103.
  65. Edvardsson V, Palsson R, Olafsson I, et al. Clinical features and genotype of adenine phosphoribosyltransferase deficiency in iceland. Am J Kidney Dis 2001; 38:473.
  66. Carpenter TO, Lebowitz RL, Nelson D, Bauer S. Hereditary xanthinuria presenting in infancy with nephrolithiasis. J Pediatr 1986; 109:307.
  67. Sadler L, Stapleton FB. Disorders of porphyrin, purine, and phyridimine metabolism. In: Current Pediatric Therapy, 15th ed, Burg FD, Ingelfinger JR, Wald ER (Eds), WB Saunders, Philadelphia 1994.
  68. Zibolen M, Srsnova K, Srsen S. Increased urolithiasis in patients with alkaptonuria in childhood. Clin Genet 2000; 58:79.
  69. Samuel M, Duffy P, Capps S, et al. Xanthogranulomatous pyelonephritis in childhood. J Pediatr Surg 2001; 36:598.
  70. Bingöl-Koloğlu M, Ciftçi AO, Senocak ME, et al. Xanthogranulomatous pyelonephritis in children: diagnostic and therapeutic aspects. Eur J Pediatr Surg 2002; 12:42.
  71. Zugor V, Schott GE, Labanaris AP. Xanthogranulomatous pyelonephritis in childhood: a critical analysis of 10 cases and of the literature. Urology 2007; 70:157.
  72. Hussein N, Osman Y, Sarhan O, et al. Xanthogranulomatous pyelonephritis in pediatric patients: effect of surgical approach. Urology 2009; 73:1247.
  73. 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.
  74. Sternberg K, Greenfield SP, Williot P, Wan J. Pediatric stone disease: an evolving experience. J Urol 2005; 174:1711.
  75. Fontaine E, Gagnadoux MF, Niaudet P, et al. Renal transplantation in children with augmentation cystoplasty: long-term results. J Urol 1998; 159:2110.