Situated in the so-called "kidney stone belt" stretching across the southern U.S., Arkansas Children's is perfectly positioned to address the increasing prevalence of kidney stones in children. The health system is doing just that with the recent establishment of Arkansas' only pediatric kidney stone clinic, a multidisciplinary effort that provides the personalized care children need to manage and prevent kidney stones.
"Unlike adults, children are much more likely to have an underlying metabolic condition that causes kidney stones," said Rachel Millner, M.D., pediatric nephrologist and co-director of the Complex Urology Clinic at Arkansas Children's Hospital and assistant professor of pediatrics in the Division of Pediatric Nephrology at the University of Arkansas for Medical Sciences. "Children require a more detailed workup and plan for diagnosis and management of kidney stones. Additionally, children are not just little adults. They need expert surgical care that only a pediatric urologist can provide."
On the rise in children over the past two decades, possibly due to sedentary lifestyles, high-sodium diets, poor hydration and increasing obesity, kidney stones can affect children as early as infancy. Teenagers, however, are the most susceptible. Calcium stones are the most common pediatric kidney stones.
Kidney stones can be quite painful, lead to time out of school and contribute to significant health care costs for families," Dr. Millner said. "Some kidney stones are preventable, and having a team that knows how to manage a kidney stone or prevent or decrease future stones is very important."
Community pediatricians should watch for children who present with back, flank or abdominal pain, pain with or difficulty initiating urination, and blood in the urine, all of which may indicate a kidney stone. In young, nonverbal children, kidney stones may cause unusual irritability.
"A provider should suspect a kidney stone in the setting of sudden-onset flank or abdominal pain that doesn't get better with rest or lying still," Dr. Millner said. "Children are often seen in an emergency department for the first stone because many other conditions can cause similar pain. Once a stone is identified, the child should be evaluated by a pediatric urologist to determine if surgical treatment is necessary. A nephrologist's input is needed to help determine the cause of the stone and create a personalized plan to prevent future stones."
In 2023, Arkansas Children's established the Kidney Stone Clinic within the Pediatric Urology Clinic. The new clinic has its roots in some eye-opening data that emerged from the UroNeph Clinic, which Arkansas Children's started in 2018 to bring together a urologist and nephrologist to treat children with complex bladder and kidney conditions.
"We found that about 30% of the children we saw in that clinic had kidney stones," Dr. Millner said. "On further investigation, we learned that many children not seen in our clinic were still seeing urologists and nephrologists separately or only seeing one and not the other. This prompted us to realize that creating a new clinic dedicated to kidney stones would provide the opportunity to focus on delivering state-of-the-art care and simplifying follow-up for families."
At the Kidney Stone Clinic, patients see a pediatric urologist or urology nurse practitioner, pediatric nephrologist, and dietitian during one appointment, and most receive an ultrasound. Together, the clinicians create a unique treatment plan. Arkansas Children's Hospital offers a full range of options for acute kidney stone management, including treatments to extract or break up large stones. Chronic management is also available.
"We provide long-term management with ultrasound surveillance, 24-hour urine collections to assess urinary risk factors for kidney stone formation, targeted dietary interventions for stone prevention, and medication management," Dr. Millner said. "We use this information to create an individualized plan for each child that targets the root cause of their kidney stones."
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