The occurrence of a kidney stone in a child is a relatively rare event. In countries where plants are the main source of protein in the diet, for example Southeast Asia, the Middle East, India, and Eastern Europe, the frequency of kidney stone disease in children rises. In developing countries, bladder stones made of uric acid are more commonly found.
Symptoms of kidney stones in children are similar to those in an adult, although with very young children or infants, the symptoms may be harder to appreciate and understand. The initial finding in an infant may be a crying and inconsolable baby, and the presentation may be mistaken for colic.
Monday, January 17, 2011
Kidney Stones Diagnosis
The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone. Many other conditions can mimic this disease, and the care provider may need to order tests to confirm the diagnosis. In older patients, it is always important to at least consider the diagnosis of a leaking or ruptured abdominal aortic aneurysm (abnormal widening of the large blood vessel that leads from the heart to supply blood to the body) as a source of this type of pain.
Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often done to look for potentially dangerous conditions. The care provider may palpate or feel the abdomen trying to find a pulsatile or throbbing mass that might indicate the presence of an abdominal aortic aneurysm. Listening to the abdomen with a stethoscope may reveal a bruit or rushing noise made by abnormal blood flow through the aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease. Tenderness in the lower quadrants may be associated with appendicitis, diverticulitis, or ovarian disease. Examination of the scrotum may exclude a testicular torsion.
In children, colicky abdominal pain may be associated with intussusception of the intestine.
Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.
Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.
Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.
Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to interpret the images and may not always be available.
In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder. As well, in patients with known kidney stone disease, no imaging may be necessary if the diagnosis seems certain, so that the amount of X-ray radiation that can accumulate over a lifetime is minimized.
Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often done to look for potentially dangerous conditions. The care provider may palpate or feel the abdomen trying to find a pulsatile or throbbing mass that might indicate the presence of an abdominal aortic aneurysm. Listening to the abdomen with a stethoscope may reveal a bruit or rushing noise made by abnormal blood flow through the aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease. Tenderness in the lower quadrants may be associated with appendicitis, diverticulitis, or ovarian disease. Examination of the scrotum may exclude a testicular torsion.
In children, colicky abdominal pain may be associated with intussusception of the intestine.
Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.
Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.
Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.
Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to interpret the images and may not always be available.
In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder. As well, in patients with known kidney stone disease, no imaging may be necessary if the diagnosis seems certain, so that the amount of X-ray radiation that can accumulate over a lifetime is minimized.
Kidney Stones Causes
There is no consensus as to why kidney stones form.
* Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).
* Geographical location: There may be a geographic predisposition, and where a person lives may predispose them to form kidney stones. There are regional "stone belts," with people living in the southern United States having an increased risk of stone formation. The hot climate in this region combined with poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.
* Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet probably will not change that risk.
* Medications: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) may form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro).
* Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
* Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a type of salt), and uric acid (as in gout).
* Geographical location: There may be a geographic predisposition, and where a person lives may predispose them to form kidney stones. There are regional "stone belts," with people living in the southern United States having an increased risk of stone formation. The hot climate in this region combined with poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.
* Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet probably will not change that risk.
* Medications: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir (Crixivan) may form indinavir stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like ceftriaxone (Rocephin) and ciprofloxacin (Cipro).
* Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
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