Urolithiasis in Children—Treatment and Prevention

Abstract

The incidence of stones is increasing in children especially among Caucasian adolescents. Every child with stones deserves an evaluation because the majority has a diagnosable metabolic defect and 50 % will have a recurrence of stones. Diet, sedentary lifestyle, and climate change contribute to the changing frequency of stones. There is some evidence to support the following lifestyle changes: high fluid intake, low sugar intake, low sodium intake, higher plant protein intake and lower animal protein intake, normal calcium intake, high potassium citrate intake, moderate exercise, and reduced environmental temperature. Our challenge is to help our patients commit to and maintain a healthy lifestyle. After dietary influences, having a family member with nephrolithiasis poses the greatest risk. Identifying the underlying defect that permits stones to form in some members of the family will permit targeted therapy. For instance there is a “gain of function” mutation in the calcium-sensing receptor gene in families with autosomal dominant hypocalcemic hypercalciuria. Treating these patients with vitamin D to increase the blood calcium results in marked hypercalciuria, nephrocalcinosis, and nephrolithiasis. Thus, the second challenge in addition to lifestyle changes is to identify the gene defects permitting stone formation.