Medical Professional Publications

Urinary Stone Disease Signals Substantial Future Morbidity, Even for Children

Columbus, OH - May 2016

Urinary stone disease traditionally has been treated by removing or facilitating the passage of stones. Clinicians have long believed that was enough; patients would return to a baseline after a painful acute event.

A growing number of studies shows that belief to be mistaken. Urinary stone disease is instead a multi-system condition, associated with atherosclerosis, hypertension, chronic kidney disease and low bone mineral density. While usually thought of as an adult issue, studies from Nationwide Children’s Hospital and other institutions have linked urinary stones to atherosclerosis and low bone density in children as well.

A conference hosted by the National Institutes of Health last year, and a recent publication in the Clinical Journal of the American Society of Nephrology, has drawn attention to how much there is yet to discover about the long-term implications of urinary stone disease.

“The biggest problem is that the incidence of stones is increasing,” says Andrew Schwaderer, MD, co-organizer of the conference, coauthor of the paper and research director in the Division of Nephrology at Nationwide Children’s. “Approximately 1 in 10 people have them. It’s a smaller number in children, but urinary stones are increasing in children as well.”

“We now know that there are these other associated morbidities,” he continues. “But we don’t have any new treatments for urinary stone disease.”

The publication identified five key priorities for research:

  • Epidemiology, such as the causes of the increasing prevalence of urinary stone disease in children
  • Microbiota, such as the influence of urinary and gastrointestinal microbiota in the disease
  • Exposome, such as the influence of diet and climate
  • Prevention, such as the role of increased water intake
  • Care delivery, such as optimal evaluation of patients and decreasing ureteral stent discomfort

From a care perspective, urinary stones are more likely to be missed or misdiagnosed in the pediatric population than in adults, says Dr. Schwaderer, who is also a principal investigator in the Center for Clinical and Translational Research in The Research Institute at Nationwide Children’s. Primary care doctors don’t always realize how common the stones can be in children, so they assume that certain symptoms are the result of urinary tract infections.

More awareness in the pediatric primary care community is important, both of urinary stones’ prevalence in children and of the stones’ relationship to other health conditions.

“Treatment in children can be very inconsistent because urinary stones are often viewed as an adult disorder,” Dr. Schwaderer says. “When a urinary stone is suspected in a child, the child should be referred to a pediatric nephrologist or pediatric urologist.”

Reference:
Scales CD Jr, Tasian GE, Schwaderer AL, Goldfarb DS, Star RA, Kirkali Z. Urinary stone disease: advancing knowledge, patient care, and population health. Clinical Journal of the American Society of Nephrology.  2016 Mar 10. [Epub ahead of print]

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