A kidney stone in a child is a more rare phenomenon compared to a similar formation in the urinary system of an adult. However, children can also suffer from urolithiasis, also called urolithiasis or nephrolithiasis.
And the stone itself, as in adults, is a formation consisting of certain salts and organic compounds contained in urine. This pathology is usually caused by metabolic disorders, but they can have a very different nature.
Reasons for education
It is believed that if there are kidney stones in children, the causes are congenital abnormalities in the structure of the kidneys and urinary tract.
In fact, studies have shown that these abnormalities are the cause of urolithiasis in only 48% of cases. At the same time, factors such as:
- genetic predisposition to such a disease;
- prematurity factor;
- the effects of various harmful substances on the mother’s body during pregnancy and even before it (this is not necessarily smoking, it may be work in chemical industries);
- pregnancy with complications, severe toxicosis or gestosis.
It is interesting that breastfeeding or, conversely, nutrition with artificial mixtures does not affect the process of stone formation. When a child grows up, irregular nutrition still plays a negative role, as does the abuse of junk food and convenience foods.
Also, at a later age, enzymatic disorders, hyperthyroidism, and kidney diseases can play a negative role. It should be noted that urolithiasis is often combined with chronic pyelonephritis, but it is not always the root cause of its development.
Kidney stones at 2 years of age are detected quite rarely. Usually, the first signs of urolithiasis are recorded later, unless its development is really associated with congenital anomalies of the internal organs or with a genetic predisposition.
There is a theory that in childhood, the primary cause of stone formation can be an infection of the urinary organs, which takes a chronic form. In approximately 62-65% of cases, kidney stones are found in a child 3 years old or slightly older.
Symptoms of urolithiasis in children
The main symptom of urolithiasis is pain. In many ways, the signs of kidney stones in children coincide with the clinical picture of this disease in adults. However, there is an important difference. If adults are more likely to experience renal colic, then children experience aching pains that are spilled in nature, and this can significantly complicate the diagnosis of urolithiasis in a child. In addition, often the baby can not even correctly show where it hurts.
In adults, in most cases, pain is felt mainly in the lower back, while in children it can be given to the stomach. Therefore, parents often in such a situation suspect food poisoning, appendicitis or an attack of gastritis. But if the calculus is low, then the child may give pain in the leg. In boys, the glans penis may hurt.
If there are kidney stones, the symptoms in a young child will also be characteristic. Although the baby still cannot show that it hurts, the presence of pain will be noticeable by crying and general anxiety.
Additional signs
Symptoms such as:
- signs of general intoxication (weakness, lethargy, loss of appetite);
- fever, sometimes fever;
- dysuria, that is, delayed or lack of urination;
- hematuria - the appearance of traces of blood in the urine, this symptom indicates that the stone prevents the outflow of urine or even managed to damage the mucous membrane of the ureters;
- nausea and vomiting.
This clinical picture is due to the fact that at an early age, urolithiasis is most often accompanied by an infection of the genitourinary system. The passage of small stones passes with less severe symptoms, often it is detected by chance.
No symptoms
In some cases, the disease is almost asymptomatic. At least, outwardly, it does not appear in any way if the stone is small and does not interfere with the outflow of urine.
It can only be detected by ultrasound of the kidneys. This is precisely why urolithiasis is dangerous in children, because parents do not know anything about it (the child does not experience pain, there are no other external manifestations), and after some time, renal failure develops. To avoid this, you need to regularly visit a urologist.
Interestingly, in children, calcium stones are most often found. But their other types - urate calculi and jets - reveal much less often.
Diagnosis of kidney stones in children
Due to the fact that the manifestations of urolithiasis in children can be very similar to signs of pyelonephritis, acute appendicitis, cystitis, kidney trauma and other pathologies, additional diagnostics are required. This means that laboratory tests and ultrasound of the kidneys are performed. Radiological diagnostic methods are used. Of these, excretory urography is considered the most informative study. An overview of the urinary system as a whole is taken.
If the discharge of the calculus does occur, it is recommended to conduct the chemical composition of the stone (spectral analysis, optical crystallography is done).
Conservative treatment of urolithiasis
If kidney stones were found in children, treatment can be either conservative or surgical. Conservative therapy includes several directions at once, first of all, relief of a pain attack, as well as relieving inflammation and dissolving stones (which is possible only for relatively small stones).
During an attack, it is recommended to first stop the pain, for this non-steroidal anti-inflammatory drugs are used, which include, for example, Nurofen. These drugs not only relieve pain, but also prevent the development of a second attack. Such drugs are prescribed with caution in renal failure, as they can aggravate the disease. But at the same time, they do not affect healthy kidneys.
As for the dissolution of stones, the choice of drug depends on their chemical composition. For example, if these are calcium stones, then Lidase, methylene blue, and Furosemide as a diuretic are prescribed. If we are talking about the dissolution of oxalate stone, then phytin and vitamin B6 are prescribed. With a mixed type of stones, madder extract in tablets is prescribed, "Fitolizin" (it is produced in tubes), "Nieron", "Cystenal", and other drugs.
Combined phytopreparations such as Cyston, Cystenal and Kanefron N have anti-inflammatory, analgesic and diuretic effects.
If all of the conservative methods listed above did not give the desired effect, then kidney stones are crushed in children or other surgical methods are used in accordance with WHO recommendations.
Surgical treatment for kidney stones
Surgical intervention is allowed only in the presence of certain indications, which include:
- constant pain, which is felt despite the fact that the child is taking painkillers;
- severe renal impairment;
- growth of calculus in size;
- development of a secondary infection;
- hematuria, that is, the appearance of blood in the urine, which indicates damage to the walls of the organs of the urinary system.
Both the age of the child and the "age" of kidney stones matter. If they were discovered 2-3 years ago, and during this time they could not be dissolved, then they will have to be combated with more radical methods.
Various methods of surgical intervention are used.
Remote lithotripsy
In recent years, remote lithotripsy, that is, the removal of stone by crushing, has become widespread. It is not recommended for all cases, but only for those when the diameter of the calculus does not exceed 2.0 cm, and this formation itself has a relatively low density.
In developed countries, uroretgenological tables are used for this, in which modern lithotripters are already built.
The impact on the stones in this case is carried out using the methods of shock wave therapy, when waves of this type are directed at the stone, acting on it with a certain frequency. The power of this wave, its other characteristics, the number of repeated sessions - all this is determined by the attending physician.
Remote lithotripsy is contraindicated in hemorrhagic diathesis, in the presence of an unhealed urinary tract infection, as well as in cases where there are serious deformations of the musculoskeletal system, or when a small patient is obese.
Contact lithotripsy
If it is a large calculus, then contact lithotripsy methods are used . One of the most common is percutaneous nephrolithotripsy.
It is used when the diameter of the calculus exceeds 2 centimeters, or when the diagnosis shows the presence of multiple kidney stones. Sometimes it is carried out in cases where the remote technique did not give the desired result.
But with an infection of the urinary system, this type of operation is contraindicated, as well as in the presence of tumors of any origin.
Open operations are currently extremely rare, as they involve the most traumatic intervention.
Conclusion
Nephrolithiasis is a serious disease that requires qualified medical attention. Self-treatment, especially the methods of traditional medicine, as many advise, not only does not solve the problem, but can aggravate the situation.