A 14-year-old boy with urolithiasis and hypercalcemia: Answers

Kidney Stones in Children: Causes, Consequences, and Concerns

The prevalence of kidney stones (nephrolithiasis) in children has been steadily rising in the last two decades. The commonly reported environmental causes for this rise in the prevalence of nephrolithiasis include obesity, increased intake of fructose-containing energy drinks, increased sodium content in junk foods, decrease in water intake as well as poor oral calcium intake, and increasing usage of antibiotics that deplete the oxalate-metabolizing bacteria in the gut. Increased detection of monogenic causes of nephrolithiasis is being facilitated with the easy availability of next-generation sequencing (NGS). These include primary hyperoxaluria types 1, 2 and 3, hypercalciuria (including monogenic and idiopathic types), hyperuricosuria (including Lesch-Nyhan syndrome, and urate transporter defects, etc.), cystinuria, hereditary xanthinurias, adenine phosphoribosyl transferase (APRT) deficiency (causing 2, 8 dihydroxyadenine stones) etc. The evaluation of pediatric nephrolithiasis includes a comprehensive history taking, examination, basic imaging using renal ultrasound, metabolic evaluation and genetic testing. The recurrence risk for kidney stone occurrence in children is high, placing them at risk for severe morbidities including renal colic, urinary tract infections, acute kidney injury and chronic kidney disease. The management of nephrolithiasis in children necessitates a multidisciplinary approach involving pediatricians, pediatric nephrologists, urologists, dietitians, and nurses.  While medical advancements offer effective treatments for kidney stones in children, prioritizing prevention and accurate diagnosis with the usage of appropriate genetic and metabolic work-up remains crucial for optimal management.