A personalized approach to treating kidney stones
One in 10 people in their lifetime will have a kidney stone — a small, hard deposit of mineral and acid salts that can obstruct the drainage of urine, cause intense pain and, if not treated properly, lead to long-term kidney issues. Kidney stones are relatively uncommon in children, but the number of cases over the past two decades has risen. The treatment for kidney stones has remained the same for decades — increased fluid intake, limited sodium intake, diuretics and potassium citrate therapy. Lifestyle factors are typically blamed for kidney stones, yet twin studies suggest a genetic component. In fact, new research supports pursuing a genetic diagnosis for this common condition, especially in kids. “The minute we find a mutation that causes disease, we have the cause of disease in hand,” saysFriedhelm Hildebrandt, MD, chief of the Division of Nephrology at Boston Children’s Hospital. “And finding the cause has consequences for therapy.” Single-gene causes of kidney stones In 2014, a study led by Hildebrandt identified a causative single-gene mutation in a surprising 21 percent of children and 11 percent of adults. “We therefore wanted to study a pediatric cohort of our own patients at Boston Children’s Hospital,” Hildebrandt says. In a second study, he and his colleagues analyzed 30 known causative genes in 143 children with kidney stones (nephrolithiasis) or nephrocalcinosis, a related condition in which c...
Conclusion: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.
A 68-year-old Black female with a history of hypertension, type II diabetes mellitus, nephrolithiasis complicated by recurrent pyelonephritis status post lithotripsy and nephroureteral stents, and stage IIIB diffuse large B-cell lymphoma (DLBCL) in complete remission 30 months after completing therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) presented to the Emergency Department with three days of subjective fever, left flank pain, nausea, and vomiting.
ConclusionComplications frequently occur in EPN patients as compared to pyelonephritis.
ConclusionsWe conclude that specific urinary metabolic risk factors can be found in most children with kidney stones, with hypercalciuria and hypocitraturia being the most common diagnoses.Graphical abstract.
Conclusion: ESPB performed under fluoroscopic guidance is a simple and effective technique and it provides significantly better postoperative pain relief.
AbstractAlthough kidney stones are less common in children than in adults, incidence in children is rising. Kidney stones may lead to significant morbidity in addition to escalating medical costs. Clinical presentation is variable. Bilateral kidney stones in a younger child should prompt work-up for primary hyperoxaluria. Metabolic abnormalities are more frequent in children and can result in frequent stone recurrence. Whole exome sequencing data shows genetic defects in about 30% of stone formers. 24 h urine collection should be conducted when patient receives his usual diet and fluid intake with normal activity. In...
ConclusionsPatients prescribed new opiates for acute nephrolithiasis and those with an existing opioid prescription are likely to require refills before resolution of the stone episode. Larger stones that require surgery (not spontaneous passage) also increase the risk. Timely treatment of these patients and initial treatment with non-narcotics may reduce the risk of prolonged opiate use.
AbstractObjectiveTo study the etiological profile and patterns of clinical presentations of urolithiasis (UL) in children.MethodsThis observational study included patients
We present a case of a patient with hematuria and flank pain typical of nephrolithiasis who was diagnosed with a Page kidney causing secondary hypertension.A 50 year-old male with no significant past medical history presented to the Emergency Department with severe left-sided flank pain, vomiting, and blood-tinged urine.
CONCLUSION: Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment. PMID: 32686567 [PubMed - as supplied by publisher]