Kidney stones affect kids even at 2, lifestyle blamed Mumbai:
Kidney stones, once considered a problem of the grown-ups, is
now showing up in children as young as two years old. Ask Powai residents Minal and Mehul Joshi (names changed), who were “shellshocked’’ when doctors recently told them that 18-month-old Yash’s frequent bouts of urinary tract infection had resulted in the formation of a complex stone, Staghorn calculi, in his kidneys. “One has always associated kidney stones with uncles and grandfathers. Moreover, it seemed that the condition was easy to resolve with medicines. But we were devastated to learn that our son needed a procedure to get rid of stones that had developed in both his kidneys,’’ says Minal. The mother believes that it’s poor water intake that worsened her son’s plight. However, a study released in the Journal of Pediatrics in April 2010 enumerates how a host of lifestyle reasons—from increased intake of salt, lowered intake of milk, obesity and changed usage of antibiotics—doubled the incidence of kidney stones in children in US’ South Carolina between 1996 and 2007. As there are no local studies on paediatric kidney stones, doctors here give varied opinions but acknowledge it’s a cause for concern.  Steps
towards Prevention Cut down on colas, drinks high in sugar or salt. A Wisconsin univ doctor has warned it’s not just salty chips and French fries, but also processed foods like canned soups, packaged meals and even sports drinks like Gatorade that can lead to stones in children Dairy products can reduce the risk of stones because dietary calcium binds with oxalate before it reaches kidney Kids between five and 10, who have stones, should drink six glasses of water a day Be active, prevent obesity ‘Processed foods and salt are key culprits’ The Mumbaibased Paediatric Oncall journal says that “kidney stones are not very common in children, but these stones are being discovered now with increasing frequency amounting to up to one in each 1,000 childhood admissions.’’ Paediatric urologist Dr Arbinder Singhal, who operated on 18-month-old Yash using an endoscopic technique, said, “We have been seeing about seven to eight children with kidney stones every month for the last year.’’ He feels it is a measure of the growing incidence in the paediatric population that an endoscopic technique called percutaneous nephrolithotomy (Perc) that was used for grownups was recently improvised for use in children (Mini Perc). Paediatric nephrologist Dr Pankaj Deshpande says he has seen infants as young as six months old with kidney stones. “We are definitely seeing more children than before,’’ he adds.  Most
kidney stones occur when oxalate, a byproduct of some foods,
binds to calcium in the urine. Other common stones are calcium
phosphate stones and uric acid stones. American researchers feel
that the binding process is enhanced when children don’t drink
enough fluids and eat foods with high salt content. A New York
Times article quoted Dr Bruce L Slaughenhoupt from the
University of Wisconsin as saying that “it is not just salty
chips and French fries, but also processed foods like sandwich
meats; canned soups; packaged meals; and even sports drinks like
Gatorade’’ that led to stones in children. While no such
reasons are established in India, Dr Deshpande feels that the
only lifestyle reason he would identify is the rampant use of
calcium supplements. “Another reason could be better
availability of technology. A decade back, an ultrasound
screening wasn’t as frequently prescribed as it is today for
children,’’ he says. However, Dr N K Hase who heads the nephrology department of KEM Hospital doesn’t feel that the number of paediatric kidney stone cases have gone up significantly. “Children could have kidney stones either because of tubular disorders or due to frequent infections, and not necessarily due to diet,’’ he says. UNUSUALLY YOUNG? Yash Joshi was six-months-old when he first got a urinary infection. After bouts of urinary infections, a CT scan at 17 months of age showed large kidney stones in both his kidneys. “Staghorn calculi are complex stones that extend deep inside into branches of urinary drainage system,’’ says paediatric urologist Dr Arbinder Singhal, who teaches at MGM Hospital, Vashi. The stone from his right kidney was removed on June 24 and the other on July 12. “The stents and tubes placed have been removed. Yash is doing well,’’ said Yash’s parents KIDNEY STONES: WATCH WHAT YOU EAT Diet for calcium oxalate stones Avoid a high protein diet Avoid taking vitamin, mineral supplements Avoid too much vitamin C and calcium containing antacids Avoid vegetables and fruits containing seeds such as tomatoes, guava etc Diet for uric acid stones Avoid purine rich foods Increase fluid intake Decrease animal protein Kidney stones come in varying sizes, and form inside the kidneys, ureter, urinary bladder or the urethra. If the concentration of a particular mineral in the urine is too high, crystals form, which sometimes become kidney stones RISK FACTORS Congenital abnormality Not drinking enough fluids Eating too much salt Excess amounts of processed foods, including smoked and cured meats, as well as sodas and canned products that have the highest sodium content Excessive intake of tea, coffee, dark chocolate, spinach, nuts and wheat bran can also increase the risk of certain types of kidney stones Childhood obesity is a risk factor SYMPTOMS Back and/or and abdominal pain Blood in urine Urinary infections Pain in urination or frequent urination Parents may often mistake their child’s symptoms for appendicitis or gastritis TREATMENT If stones are small (less than 5mm), they will pass out naturally. Medicines may help If the stone is small and in a suitable location, shockwave lithotripsy can be used. The procedure occurs under an anaesthetic. Sound waves are used to break up the stone into small pieces. This is possible only for children more than 3-4 years of age For the stones stuck in the urinary pipe (ureter), ureteroscopy can be performed. A miniature telescope is passed through the natural passages into the urinary system and the stones are treated with a laser |