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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