Management of Pediatric Kidney Stones
Acute Managment:
• Pain relief: NSAIDs, opioids
• Facilitating passage of stone: majority < 5 mm will pass spontaneously
• IV Hydration: 1.5-2 x Maintenance
• Can consider medical expulsive therapy (MET): e.g..Tamsulosin
• Try retrieve stone using urine strainer: send for stone analysis
Surgical Rx:
• ACUTE:
- If persistent severe pain, Obstruction, Anuria
- PCN: Obstructed system
• ELECTIVE:
- Stone> 5 mm: unlikely to pass
- ECWL +/- Stent: < 2 cm stone
- URS: Ureteric stone
- Open surgery: rare
Prevent Recurrence:
• For ALL patients - High Fluid intake: at least 2L/1.73 m2
• HYPERCALCIURIA
- Calcium as per RDI
- Avoid excessive animal protein
- Low sodium diet
- Thiazides: if dietary measures fail
- Potassium Citrate
- Neutral phosphate
Targeted Rx:
• PRIMARY HYPEROXALURIA
- Avoid high oxalate food
- Potassium citrate, neutral phosphate
- Pyridoxine in pyridoxine responsive patients
- Monitoring for extra-renal involvement: eyes, TFT, ECG, FBE, Bone Xrays
- Dialysis
- Transplant: Liver and/or kidney
- Other: Lumasiran
• HYPERURICEMIA
- Avoid high Protein diet
- Urine alkalinisation: potassium citrate
- Allopurinol, Febuxostat
• CYSTINURIA
- Avoid high Protein diet
- Urine alkalinization: potassium citrate
- Captopril, Tiopronin, d-Penicillamine, ascorbic acid
Dr. Swasti Chaturvedi @SwastiThinks
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