Nephrolithiasis: Approach to Diagnosis and Management
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REVIEW ARTICLE
Nephrolithiasis: Approach to Diagnosis and Management Andrea J.S. Ang 1 & Ashley A Sharma 2 & Amita Sharma 3 Received: 6 January 2020 / Accepted: 17 June 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Although kidney stones are less common in children than in adults, incidence in children is rising. Kidney stones may lead to significant morbidity in addition to escalating medical costs. Clinical presentation is variable. Bilateral kidney stones in a younger child should prompt work-up for primary hyperoxaluria. Metabolic abnormalities are more frequent in children and can result in frequent stone recurrence. Whole exome sequencing data shows genetic defects in about 30% of stone formers. 24 h urine collection should be conducted when patient receives his usual diet and fluid intake with normal activity. Infrared spectroscopy and X-ray diffraction are used for stone analysis. Urine studies should be delayed by 4–6 wk after stone fragmentation or treatment of any stone related complications. The goal of evaluation is to identify modifiable risk factors for which targeted therapy may be instituted. Primary indications for surgical intervention include pain, infection and obstruction. Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) are most commonly used, and selection is based on stone size, anatomy, composition and anatomy. Advances in technology have allowed a shift to minimally invasive surgeries. Comprehensive management requires multidisciplinary team. Children with kidney stones require long term follow-up with periodic assessment of stone forming activity and ascertaining stone burden. High index of suspicion should be there to diagnose diseases like primary hyperoxaluria, Dent’s disease, renal tubular acidosis (RTA) etc. as these diseases have ramifications on kidney function and growth. Keywords Kidney stone . Epidemiology . Evaluation . Management . Recurrence
Introduction Kidney stones in children cause significant morbidity. Its incidence in developed countries has risen rapidly over the past 25 y, with especially large increases seen in adolescent females and African-Americans [1–3]. Studies in recent years have demonstrated a worrying association between nephrolithiasis and increased risks of chronic kidney disease, cardiovascular disease, and fractures in children and adults [4–6]. Management of kidney stones in adults is estimated to account for almost $2 billion in annual healthcare expenditure [7], while pediatric nephrolithiasis is expected to cost at least $375 million per year in hospital admission and emergency
* Amita Sharma [email protected] 1
Yong Loo Lin School of Medicine, Singapore, Singapore
2
Johns Hopkins University, Baltimore, USA
3
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
room costs in the United States alone [8]. In light of these trends, it is imperative for providers to use optimal strategies to diagnose and treat children with nephrolithiasis, as well as dwell int
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