Prevention of recurrent 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
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 prevention of recurrent childhood nephrolithiasis will be reviewed here. The acute management, epidemiology, risk factors, clinical manifestations, and diagnosis of nephrolithiasis in children are discussed separately. (See "Acute management of nephrolithiasis in children" and "Epidemiology of and risk factors for nephrolithiasis in children" and "Clinical features and diagnosis of nephrolithiasis in children".)
In children and adolescents with nephrolithiasis, renal stones recur frequently. This was illustrated in a large case series of 221 children from the Mayo Clinic that demonstrated two-thirds of the patients developed one or more additional stones at a mean follow-up of 59 months . Other centers have reported a lower but still substantial recurrence rate of 30 percent [2,3]. The incidence of recurrent nephrolithiasis increases if there is an identified underlying metabolic abnormality that contributes to stone formation [2,3].
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- EVALUATION FOR UNDERLYING RISK FACTORS
- Stone analysis
- Metabolic evaluation
- - Serum tests
- - Urine tests
- PREVENTIVE MANAGEMENT
- Fluid intake
- Metabolic interventions
- - Hypercalciuria
- - Hyperoxaluria and oxalosis
- - Hyperuricosuria
- - Cystinuria
- - Hypocitraturia
- - Struvite
- Complementary and alternate therapies
- Metabolic surveillance
- Recurrent stone disease
- Renal outcome
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS