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Patient Story

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A 13-year-old girl presents with pain in the right flank and mid-abdomen. Several family members have had kidney stones. Her urinalysis shows blood but no signs of infection. A pregnancy test is negative. Abdominal x-ray reveals bilateral stones (Figure 70-1). A CT shows a right ureteral stone and a non-obstructing stone in the left kidney (Figures 70-2 and 70-3). She successfully passes and catches the symptomatic stone. Stone analysis shows calcium oxalate. A metabolic workup shows idiopathic hypercalciuria as the cause of her stones.

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FIGURE 70-1

Plain abdominal x-ray showing with two subtle stones (arrows), one in the right ureter and one in the left kidney of a 13-year-old girl. (Used with permission from Julian Wan, MD.)

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FIGURE 70-2

CT of the abdomen and pelvis of the same girl in Figure 70-1, showing a right ureteral stone. (Used with permission from Julian Wan, MD.)

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FIGURE 70-3

CT of the abdomen and pelvis of the same girl in Figure 70-1, showing a left kidney stone. (Used with permission from Julian Wan, MD.)

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Introduction

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A kidney stone is a solid mass that forms when minerals crystallize and collect in the urinary tract. Kidney stones can cause pain and hematuria, and may lead to complications such as urinary tract obstruction and infection.

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Synonyms

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Kidney stone, nephrolithiasis, renal calculus, renal stone, urinary tract stone, ureterolithiasis, urolithiasis.

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Epidemiology

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  • The prevalence of kidney stones among children and adults in the US is increasing.1 Part of this increase may be due to improvements in imaging techniques.2,3 Although pediatric data are incomplete, children appear to be about 1/10 as likely to develop stones as adults.

  • Kidney stones affect children of all ages but are most prevalent among adolescents, who are also more likely than younger children to present with symptomatic ureteral stones.3,4

  • Boys and girls overall have similar rates of stone formation, although prevalence varies by age, type of stone, and geographic region.5,6

  • African-American children have a lower rate of kidney stones than white children.4,7

  • Genetic, metabolic, and anatomic disorders are the main causes of stones in children. Children are at higher risk of recurrent stones and subsequent renal dysfunction than adults for whom environmental and dietary causes are more common.4 Obesity and weight gain increase the risk of stone formation in adults;8 the effects of pediatric obesity are being studied.

  • Calcium oxalate and calcium phosphate stones are the most common in children, ...

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