What are kidneys? What do they do?

• Kidneys are two organs present in the abdomen.

• The kidneys add the waste from the body into the urine.

• The kidneys during the process of removal of waste can accumulate the waste that forms stones.

• When these grow bigger, they cause pain in the region.

• The stones can develop in one or both of the kidney.

• Some children are prone to develop stones. The smaller ones are excreted( removed) through urine but some might continue to grow significantly to cause pain( called renal colic)

• Kidney stones are relatively harmless as far as they are not big enough to block urine flow

 

SYMPTOMS

Urine infections predispose to stones. hence can present with features of urine infection- Like

• Fever, burning urine

• Nausea (Vomiting sensation)

• Moderate to severe pain in middle abdomen( sides of umbilicus)

• Lower back pain ( as kidneys are located towards the back)

• Pain in the  groin

• Change in urine colour, bleeding in urine

 

RISK FACTORS

There are increased instances of stone in these children

• High-protein, low-fibre diet

• Family history of kidney stones

• Repeated urinary infections

• Certain metabolic conditions

• Certain medications- Painkillers, calcium, Diuretics, anti-seizure medications

 

PREVENTION

• Drinking adequate water( adequate water is when urine is colourless)

• Avoid unnecessary medications

• Adequate treatment and follow up of urine infections. If repeated urine infections, then the cause has to be found

 

INVESTIGATIONS

• Based on clinical presentation, the doctor would diagnose kidney stones.

He may advise the following tests

• Urine test- looking for infections. Content of calcium and other substances can be found

• You may ask your child to pass urine through a sieve, so you can catch the stone. This stone needs to be investigated for content.

• Blood tests- to see the functions of kidney

 

OTHER TESTS

• Abdomen X-Ray- the stone shines on an X-Ray

• Ultrasound abdomen

• CT scan – rarely required( never if it’s straightforward case of stone)

 

TREATMENT

• The whole purpose is to pass the stone in urine

• If stones are smaller, then painkillers are sufficient to control the situation. unfortunately, nothing much can be done to fasten the process, other than drinking lots of water.

• Painkillers like Ibuprofen, Naproxen and oral morphine are used( talk to your doctor if any suspicion of kidney stone)

IF the stones are large- as seen by investigations

Then the following methods are used at hospital

Shockwave lithotripsy (ESWL)-

• Shock waves are used to break stones to a smaller size and help pass in the urine. IT cannot be used for all stones, it has to be sufficiently big to use this method

Nephrolithotomy (PCNL)–

• A thin tube is passed to the kidney from the lower back and stone is removed

Surgery –

• To remove the stone. the stone has to be big to warrant this procedure. Rarely used

 

DANGER SIGNS

• Fever, shivering

• Not able to pass urine

• Previous kidney issues