Issue link: https://viewer.e-digitaledition.com/i/862068
FROM THE L ATE 1990s to the ea rly 2000s, kidney stone disease in children and teens has increased fivefold and now accounts for 1 in 685 hospita l admissions. A resident of the U.S. has a 9% chance of being diagnosed with a kidney stone in their adult life. 40-50% of children with kidney stones have an identifiable metabolic abnormality. Children with an underly- ing metabolic abnorma lity are more likely to have recurrent stones. While severa l factors may contribute to this rise, the key to prevention, a long with better disease ma nagement, may revolve around educating patient families about dietary modifications. The increase in incidence and preva lence can be attributed to major dietar y and environmenta l changes in the U.S. For example, today 's children drink significantly less water and milk than previous generations, and consume more sodium through processed foods. This results in a n imba lance of solutes, stone promoters and stone preventers in the urine – and kidney stones are more likely to form. As with adults, kidney stone attacks can be extremely painful in children and teens, prompting emergency room visits and hospita lizations. While the symptoms of stones in children can mirror those of adults and may include blood in urine, acute severe abdomina l pain, nausea and vomiting, they may be more nonspecific — especia lly in younger children with symptoms like genera lized abdomina l discomfort, and in the case of an infant, merely blood in the diaper. The treatment of children with kidney stones is similar to adults — oŠering pain management and increasing hydration to a llow sma ll stones to pass on their own, or removing larger stones surgica lly. The concern in both patient populations is the morbidity associated with repeated hospita lizations a nd the risk of worsening kidney function with recurrent kidney stones. A multidisciplina r y approach to disease ma nagement is pa ra mount for teens a nd children whose ca re ca n of ten be frag mented due to the va riet y of medica l exper tise that is often required. In some cases, the urologist and nephrologist a re at dif ferent institutions, or the input of a dietitia n is not a lways consistent. The dietitia n's role is pa r ticula rly critica l, since they can work with patients to identify factors in their diet that may be causing the metabolic abnorma lity. They ca n g uide patients through dieta r y inter ventions a nd follow their prog ress on the path towa rd prevention. This individua lized approach to the patient 's diet is necessa r y, since diets high in fat, suga r a nd processed foods a re not necessarily the only problematic ones. Without proper educa- tion, low-ca rbohydrate, high-protein a nd even vega n diets ca n put children a nd teens at higher risk for kidney stones. Overa ll, this coordinated approach to ca re ca n improve patient satisfaction, plus patient compliance and outcomes. Wit h recent resea rch suggesting a possible a ssociation between stone formation, bone a nd ca rdiovascula r hea lth, prevention becomes even more critica l in our youngest population of patients. Dr. Shefali Mahesh is the director of the division of Pediatric Ne phrology at A k ro n C hildre n's Hos pital . S h e i s board certified in Pediatric Nephrology by the American Board of Pediatrics. ■ The Rising Incidence of Kidney Stone Disease in Children: Challenges and Steps toward Prevention BY SHEFALI MAHESH, MD C L I N I C A L S E C T I O N : P E D I A T R I C N E P H R O L O G Y ❰❰❰❰❰ 1 5