Kids with Kidney Stones

zoobyshoe

A friend of mine just got told by a doctor he might have kidney stones. I was a bit shocked since he's 24. Googling, I found this:

http://www.nytimes.com/2008/10/28/health/28kidn.html

Evo

There are different types of stones and they are caused by different things. It would seem that children today are eating diets too high in calcium, (supplemented calcium, to be specific, like everything now is "calcium enriched", protein, and soy, all of which are known to contribute to stones.

Seems apple and grapefruit juice are on the bad list. Jimmy, you drink a lot of grapefruit juice?

http://health.nytimes.com/health/gui...revention.html

When I was in my teens, I was diagnosed with high levels of uric acid (I would have terrible pain in my left arm) and had to take ziloprim for years. I'm wondering if the repeated "gall bladder" attacks they said I had wasn't actually stones. They kept hospitalizing me to remove my gall bladder, then suddenly the pain and vomiting would stop and I'd be perfectly fine and the doctors were always baffled.

http://www.biology-online.org/articl...ey_stones.html

zoobyshoe

My friend is rather obese and sedentary, so I'm sure his diet is the cause. Still, I didn't realize this problem ever affected kids.

Would gall stones have just cleared up somehow?

Evo

It could be due to the overloading of children with supposedly "healthy foods". Everything in moderatation.

I don't know about gall stones, but if it wasn't my gall bladder (they were just guessing) I could have passed a stone, explaining the miraculous "cure".

zoobyshoe

The article I found linked it to salt and lack of fluids:

Evo

Excess salt can contribute to calcium stones, but I don't see it linked to other stones. (Evo hugs her salt container)

A couple of good articles.

http://kidney.niddk.nih.gov/kudiseas...tonediet/#salt

http://kidney.niddk.nih.gov/Kudiseas.../stonesadults/

Timely of you to post this, I have been vomiting and experiencing intense pain in my right lower flank for two days and almost went to the ER last night when my body temp dropped to 93.7 and started to pass out. The last time I did pass out and woke up on the bathroom floor with my lower teeth broken through the area below my lower lip and blood everywhere. Apparently I blacked out as I was vomiting into the toilet and slammed my face into the toilet rim. As usual with these "attacks" stuff was shooting out of both ends, it's good I live alone, that's rather embarrassing, but it's always the same, since I was in my teens. No wonder my doctor just shakes his head when he sees me.

Rhody, how is your stone? And Monique had an attack recently IIRC. Of course Jimmy S is the scariest, whenever I start to feel sorry for myself, I think about what he's gone through and suddenly I don't feel so bad.

zoobyshoe

Reminds me of what Ivan just posted in Random Thoughts:
Personally, I'd be at the clinic right now.

Andy Resnick

Stone formation is a topic somewhat related to my research (renal function)- what I know is very general and fragmented. The generation of stones reflects a more general pathology than increased salt load, and is generally not correlated with diet.

Evo's links are a reasonable place to start. The overall process in a renal nephron is here:

http://en.wikipedia.org/wiki/File:Ki...rt_diagram.png

Most of the fluid from blood enters the nephron through the glomerulus, and as the fluid is transported along the nephron, almost all of the fluid and solutes are transported back into the blood- this is the essence of 'homeostasis'. Each kidney processes over 160 liters of fluid per day.

As you can see on the diagram, different solutes are resorbed at different locations- different classes of diuretics (potassium sparing ones like amiloride, Na/Cl blockers like thiazides, loop diuretics, etc.) work at different locations on different, specific, ion transporters. The majority of resorption, >80%, occurs early, in the proximal tubule and loop of Henle. For Ca2+, this transport is paracellular and passive. Further downstream, Ca2+ is transported through the cell via passive diffusion through a Ca channel on the apical side and is excreted into the blood by a 3Na+/1 Ca 2+ antiporter.

That's how Ca2+ is handled: Ca2+ transport is largely disconnected from Na+, high Na+ levels in the blood instead translates to hypertension, since 99.5% of all Na+ is resorbed into the blood and water follows sodium. Ca2+ concentration in the nephron in itself does not correlate to stones: astronauts excrete huge amounts of calcium (1% of bone mass is lost per month on orbit) and don't (AFAIK) have an increased rate of stone formation. What matters is not only the concentrations of Ca2+, oxalate, and phosphate, but also the pH and levels of citrate: citrate and other compounds like nephrocalcin allow the stable existence of supersaturated calcium oxalate and calcium phosphate. The kidney has multiple systems to adjust and control the pH, and renal acidosis is highly correlated with stone formation.

I'm not sure on the rate-limiting step: nucleation or growth. Cloudy urine is caused by albumin secretion and is not related to stones. Gallstones are totally different- those are cholesterol.

zoobyshoe

What do you think might be causing the increased incidence of kidney stones in children? This is the first I heard of it. It's surprising and mysterious.

Evo

I think this goes with what Andy was saying.

http://kidney.niddk.nih.gov/kudiseas...neschildren/#4

rhody

Thanks for asking Evo. You meant 97.3 temperature last night right, not 93.7 which would be very dangerous, if not outright impossible.

There seems to be no real common thread and or symptom most people can hang their hat on as to when and why we get them and what discomfort they cause. I can only speak from personal experience. Didn't have my first attack till mid 40's and then because I was tired, dehydrated and drank a decent amount of beer the day before. I drink even at night now, and to my dismay, had another stone or small piece of sand pass on the same side (left) a few years later. I attribute the second one to stress, just had experienced a two year slow slide where my father in law passed away, and on the day of the funeral before heading out I mowed his lawn on a tractor, and that's when the second one started. I took pain pills, and made it through the wake without problems, but was in pain. I strongly believe that stress contributed to it but have no scientific proof. Fast forward to today, this one, 9 millimeters, right side is about one half inch above the bladder and I and the Urologist suspect has been there a long time, months even, getting bigger as time passed. Symptoms, mild cramping (not often), nausea, getting progressively worse in the last three months, feeling bloated (from back pressure on right kidney, causing it to swell, and maybe contributing to nerve and lower back pain. A weird constellation of symptoms very different from last two times. Since I had my gall bladder out three months ago, I blamed that, even though I had large gall stones, they were NOT the cause of the nausea, because it intensified since it was removed. I know one thing, I do not pass stones quickly or easily, of that fact I am 100% sure.

From Zooby's post:
This led me to the conclusion that I have excess calcium, and that is partly due to sarcoid, but that is another story for another day. My main Dr. was concerned that I reduce the calcium in my system, and in digging around for something that would help I stumbled onto magnesium, and take two 250 mg tablets a day, on evening the other in the morning. My last blood work showed that for the first time my calcium levels were normal, which I attribute to the fact that magnesium absorbs calcium by a 2 to 1 ratio, and most Americans are deficient in magnesium to begin with. I haven't had any bad side effects from it, and if it keeps my calcium in check, then I will continue to take it. My primary Dr. was fine with the dose I was taking as well.

As to the final outcome of my current 9 millimeter stone, I am getting it removed, I will spare you the details under general anesthesia next Monday at hospital. The method the Urologist is using is the safest, (laser) and the pain and recovery time should be minimal. It will be good not to feel queasy all the time. I learned a valuable lesson, don't take a symptom for granted (nausea, cramping, groin pain) that it could not be a kidney stone and include a yearly low dose X-Ray to determine if their are any more in the "pipeline" or kidney. I could have saved myself a whole lot of aggravation if I had followed this advice (suggested by Jimmy) I just described above. Monique, and Jimmy how are you both doing ? I know Jimmy said he has stones in his kidney, and as long as they are not causing him issues they will stay put for now. Monique, were you able to pass yours ?

Rhody...

Evo

No, tht's not uncommon for me. When I was in the hospital, they kept changing thermomoters, also my BP would drop to like 60/40 at the same time, they would have squads of nurses in there changing machines, writing the readings on a white board on the wall. My daughter and her BF were there, they had never believed me before.

I turn blue, lips are blue, I look dead.

rhody

Perhaps you have some extra-terrestrial blood in you then, and that BP, no wonder you passed out !!!

Rhody...

Evo

I'm convinced of it. But I snap right back like it never happened. In 30 minutes I'd go from deathly low to super high, they even changed my assigned nurses and CNAs incase they were up to something.

I'm just WEIRD!

Rhody, that sounds awful!!! You poor thing!! So Monday you get zapped? Do you have to stay overnight for observation?

They did an ultrasound on me last month, but the results came back "unable to view due to large amount of air", the tech told me that I had a HUGE ball of gas and ultrasound can't see though air. She couldn't even find my spleen, and I do have one.

bobze, would gas in my stomach & colon block out that much? (I'm a dummy, I know what side things are on, but not what's supposed to be in front), although it was discovered that my guts weren't all put back in the right places afer one major surgery. I didn't know there was an option.

Kurdt's getting tired of rubbing my tummy every day, any volunteers? micro, can I a get a virtual Dolphin rubbing?

Rhody, we'll talk in chat before Monday, I'm paying micro for some Dolphin intervention for you. I think the great whites are too extreme until we get those stones out.

We must support each other.

Andy Resnick

Is there actual data in changes to the incidence of stones in children, or is it 'self-selection bias'? Does the claimed increase in children correlate with an overall increase to the adult population? This was on another NIDDK site: "For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years.". Stones also correlate with age- by that I mean just as rates of cancer increase because we are living healthier and longer, perhaps stones are another disease we are privileged to contract in old age.

Another interesting result: "The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s." Does this correlate with menopause and imply hormonal effects?

I don't know the answers. What I do know is that the kidney is a regulatory organ- the function of the kidney is to maintain the body's salt and water balance. By construction, errors in the collecting duct (the part I work with) correspond to feedback errors at the < 0.1% level, and this corresponds to slow-acting diseases that generally don't manifest obvious symptoms for years or decades (hypertension, autosomal dominant polycystic kidney disease, cystic liver disease).

That said, children are showing increased rates of many diseases: athlerosclerosis, type 2 diabetes, (perhaps) kidney stones, etc. that are generally associated with adults, and diet is implicated in all of these.

rhody

Evo, below core body temp of 95 F (35 C) you should be experiencing moderate hypothermia:
You weren't shivering uncontrollably, were you ?

Rhody...

Evo

I believe. But what they can't figure out is the drops and raises in body temp, heart rate and BP. It's happened a number of times in hospitals (it's why they canceled my gall bladder surgery last time, my vital signs were so bad they were too afraid to operate for until I stabalized). No explanation. After they cancelled surgery, they kept me in the hospital for 3 days for observation to see if it happened again.

I have no idea what causes it, that last ER doctor swore he'd have an answer before I was discharged, nope.

Apparently some people get it. I have to be careful when it starts to happen, although it's not as common as it used to be.

http://www.emedicinehealth.com/hypothermia/page2_em.htm