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Kids and kidney stones

Ask an adult about kidney stones and – whether they have experienced one or not – they are likely to wince at the thought of intense, sudden pain. But kidney stones in kids? That’s not something parents often consider.

Sudha Garimella, a pediatric nephrologist with Prisma Health, said parents are often surprised to learn that their child has kidney stones, especially when they occur without pain. Often, teenagers will be referred to her after a routine urinalysis raises the prospect. Though there is no minimum age at which a child can experience the condition, it may reflect different concerns based on the age. It is extremely rare in babies.

“It’s very different from a teenager making a stone,” Garimella said. “It almost feels like we have teenagers walking around paying no attention to hydration. A lot of young people don’t consume enough fluids during the day. And the choice of fluids is very important.”

For her teen patients, Garimella puts the notion in familiar terms.

“It’s like a science experiment,” she said. “If you take a beaker and you put water in it and you start adding table salt – sodium chloride – to it, after a while, that amount of water has absorbed all of the salt. You keep adding more salt and it starts to crystallize at the bottom. The solution is supersaturated. Most teenagers have taken some science at school and they get that. I say, this is exactly what is happening in your kidney. Your urine has too little water and too much salt. Once we’ve dissolved that salt in the water, there’s no way we can suck the salt out. We have to get a bigger beaker. The cornerstone of kidney stone management is always increasing fluids.”

The issue becomes even more important during hot weather or when kids are playing sports. Garimella said she will often hear from families when their children are out of their routine – on vacation, for instance – and have forgotten to keep up with their fluid intake. 

As the temperature rises, Garimella said it is important to focus on hydration by hydrating evenly throughout the day. Carrying a water bottle along for regular sips can help. Adding lime or lemon slices to the water adds citric acid and flavor. Hydrate with water, not dark sodas or tea. Reducing sodium intake is critical. Patients may need to avoid certain foods, such as spinach and chocolate, at least until the type of kidney stone is determined.  

While the American Academy of Pediatrics recommends that children have a screening urinalysis at age 13 and older, blood in the urine should be addressed right away. A urinary tract infection is a common cause in children, but it would likely be accompanied by other symptoms.

Seek help from your child’s doctor for burning with urination, chronic belly or back pain, blood in their urine or dark or orange urine, or fever with painful urination. 

Garimella said the incidence of kidney stones in children is increasing, and that the Upstate is part of the “stone belt” of the country. Diet, fluid, climate and genetics can all play a role. 

“We can’t do much about genetics and climate, but the lifestyle we can change,” she said.