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 approximately 30 percent [2-4]. The incidence of recurrent nephrolithiasis increases if there is an identified underlying metabolic abnormality that contributes to stone formation [2,3].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc 1993; 68:241.
- Schwarz RD, Dwyer NT. Pediatric kidney stones: long-term outcomes. Urology 2006; 67:812.
- Pietrow PK, Pope JC 4th, Adams MC, et al. Clinical outcome of pediatric stone disease. J Urol 2002; 167:670.
- Tasian GE, Kabarriti AE, Kalmus A, Furth SL. Kidney Stone Recurrence among Children and Adolescents. J Urol 2017; 197:246.
- Spivacow FR, Negri AL, del Valle EE, et al. Metabolic risk factors in children with kidney stone disease. Pediatr Nephrol 2008; 23:1129.
- Remer T, Neubert A, Maser-Gluth C. Anthropometry-based reference values for 24-h urinary creatinine excretion during growth and their use in endocrine and nutritional research. Am J Clin Nutr 2002; 75:561.
- Milliner DS. Urolithiasis. In: Pediatric Nephrology, 5th ed, Avner ED, Harmon WE, Niaudet P (Eds), Lippincott Williams and Wilkins, Philadelphia 2004. p.1091.
- Choi JN, Lee JS, Shin JI. Low-dose thiazide diuretics in children with idiopathic renal hypercalciuria. Acta Paediatr 2011; 100:e71.
- Nicoletta JA, Lande MB. Medical evaluation and treatment of urolithiasis. Pediatr Clin North Am 2006; 53:479.
- Dello Strologo L, Laurenzi C, Legato A, Pastore A. Cystinuria in children and young adults: success of monitoring free-cystine urine levels. Pediatr Nephrol 2007; 22:1869.
- 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.
- Gambaro G, Favaro S, D'Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001; 37:233.
- Stapleton FB, Chesney RW, Behrmann AT, Miller LA. Increased urinary excretion of renal N-acetyl-beta-glucosaminidase in hypercalciuria. Am J Dis Child 1985; 139:950.
- Bonilla-Felix M, Villegas-Medina O, Vehaskari VM. Renal acidification in children with idiopathic hypercalciuria. J Pediatr 1994; 124:529.
- Hamed IA, Czerwinski AW, Coats B, et al. Familial absorptive hypercalciuria and renal tubular acidosis. Am J Med 1979; 67:385.
- 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS