When we think of “kidney stones,” the image of the typical patient is usually not of a fresh-faced first grader.
But Blakely Kopatz, 6, who has recently had 2 surgeries, proves that kidney stones are not just an ailment of adulthood.
Akron Children’s Hospital has created a new service – a Pediatric Kidney Stone Clinic – in response to the increasing number of children and teens experiencing the health complications of stones in the kidney, ureter and bladder.
Kidney stone disease in children and teens has increased five-fold from the late 1990s to the early 2000s and now accounts for 1 in 685 hospital admissions for children. Many experts believe the increase in incidence and prevalence can be attributed to major dietary and environmental changes in the United States.
“Children drink much less water and milk than previous generations and consume more sodium through processed foods,” said Dr. Shefali Mahesh, director of Nephrology at Akron Children’s Hospital. “Kidney stones form when there are changes in the normal balance of water, salts, minerals and other substances found in urine.”
Having cared for stone patients for more than decade, Dr. Mahesh saw the need for a multi-disciplinary stone clinic for pediatric patients in Northeast Ohio.
“Even though these children were getting the care they needed, it seemed fragmented,” said Dr. Mahesh. “In some cases, the urologist and nephrologist were at different institutions, or the input of a dietitian that is so important for a stone former, was not consistent. The need for coordinated, multi-disciplinary care for our youngest stone formers in Northeast Ohio was evident.”
Blakely’s kidney stones appear to have a genetic/metabolic connection since her mom, Angela Fisher, has had several of them her early 20s.
Blakely’s symptoms began with blood in her urine and mild stomach pain. After her second ER visit and x-ray confirmation of stones, she was referred to Akron Children’s new clinic.
During her first surgery, Dr. Curtis Clark, a pediatric urologist, used a laser to break a stone that has settled at the bottom of her left ureter. Stents were left in place to make sure swelling wouldn’t prevent urine flow. A second surgery removed the stents and two smaller stones in the right kidney and ureter.
For Fisher, having a diagnosis to explain Blakely’s mysterious symptoms was actually a relief.
“I didn’t know what to expect,” she said. “We had a 6 year old with blood in her urine. Knowing she wasn’t in pain was crazy to me. I didn’t know if she had a good tolerance for pain or she didn’t have pain.”
As part of the clinic, Blakely’s urine and stones were analyzed and she was determined to have the calcium oxalate stones, the most common type. Blakely learned that drinking at least 2 liters (8 cups) of water each day is perhaps the most important thing she can do to prevent future stones from forming.
Here are some facts about kidney stones in kids and Akron Children’s new clinic:
- Like adults, kidney stone attacks can be very painful in children and teens, prompting emergency room visits and hospitalizations. Symptoms of stones in the urinary tract may include blood in urine, generalized or acute abdominal pain, nausea, and vomiting. Treatment of children with kidney stones is similar to adults – offering pain management and increasing hydration to allow small stones to pass on their own, or using surgical techniques to remove larger stones.
- Long-term, having recurrent kidney stones puts adults and children at risk for worsening kidney function, increased bone fractures and higher rates of cardiovascular disease.
- Patient and parent education for prevention of future stone formation will be a major goal of the new clinic.
- Reducing animal protein – consider having two or more meatless days per week – increasing fruits and vegetables and limiting are also recommended ways to prevent stones. Adding lemon to water can also be helpful as citrate is a natural stone inhibitor.
“We believe that nutrition is a cornerstone for treating kidney stones,” said Dr. Kirsten Kusumi, pediatric nephrologist. “Our dietitians will be very involved in the clinic, from obtaining detailed diet history at the initial visit to guiding patients through dietary changes at follow-up visits. An in-depth analysis of the patient’s diet and stone composition will allow us to tailor our approach to the needs of each patient.”
Diets high in fat, sugar and processed foods aren’t necessarily the only problematic ones. Without proper education, low-carbohydrate, high-protein and even vegan diets can put children and teens at higher risk for stones, and special diets are becoming more prevalent in children and adults alike, noted Natalie Lussier, renal dietitian.
“This clinic is in step with Akron Children’s commitment to population health – offering health education and working to keep children out of the hospital,” said Dr. Mahesh. “With recent research suggesting possible association of stone formers with bone and cardiovascular health, its implications for our youngest populations makes this endeavor even more important.”
For more information about Akron Children’s Kidney Stone Clinic, please call 330-543-8950.