VUMC opens pediatric kidney stone clinic, first of kind in Tennessee

by Jerry Jones

Vanderbilt Children's Hospital opened a pediatric comprehensive kidney stone clinic last week, the first in Tennessee and one of only a few in the nation.

The clinic, a joint project between the divisions of pediatric urology and pediatric nephrology, will provide comprehensive services for children who are affected by kidney stones.

Tennessee lies in what doctors describe as the "kidney stone belt of the United States," and because of that, doctors are treating more and more children affected by kidney stones.

A Vanderbilt team published a study titled "Clinical Outcome of Pediatric Stone Disease" in the February 2002 Journal of Urology, indicating that pediatric patients with kidney stones were less likely to pass those stones due to the size of the stones and were more likely to have developed stones due to a metabolic disorder. The study also called for aggressive treatment.

The study, conducted by Drs. Paul K. Pietrow, John C. Pope, Mark C. Adams, Yu Shyr and John W. Brock, indicated a comprehensive treatment plan and chemical workup should be initiated on all children with kidney stones who present to physicians.

Based on that information, Brock, director of pediatric urology, Adams, associate professor of urologic surgery and pediatrics, and Pope, along with Dr. Kathy Jabs, director of pediatric nephrology, and Dr. Tray Hunley, assistant professor of pediatrics, formed the idea for the comprehensive clinic. Pope, assistant professor of urology surgery, and Hunley will spearhead the clinic.

Once a patient is referred to the clinic, doctors will meet with the patient, treat the stone if necessary, identify a cause of the kidney stone and map out a long-term care plan.

"We will be a one-stop shop," said Pope. "We can begin a treatment plan immediately. It's very important for us to find out why the child has developed kidney stones and intervene with some solutions. This will impact the kids for the rest of their lives."

Children who experience kidney stones usually develop them from one of two sources: metabolic abnormalities or infection. The study indicated that half of all children under the age of 10 who presented with kidney stones had an identifiable metabolic disorder, which produces stones with different chemical compositions and shapes. The four most common types of stones are calcium stones -- the most common of the kidney stones, caused by excessive calcium in the urine; struvite stones, also called infection stones, which are associated with bacterial urinary infections; cystine stones, a rare stone that is often genetic and develops from excessive cystine buildup in the urine; and uric acid stones, which develop when urine contains too much uric acid.

"Based on the study results, we know to immediately begin a metabolic workup on every child that presents with stones," said Lisa Trusler, a pediatric clinical nurse specialist and case manager in urology. "With the comprehensive clinic the doctors can immediately develop a plan for the patient. This makes it easier on the patients and families that are referred."

Kidney stones are not common in children. However, an estimated 1 million people in the United States develop stones. In adults, kidney stones are the third-leading reason for hospitalization and the seventh-leading cause for physician visits.

Treatment varies from hydrating the patient to force out the stone, to surgically removing the stone.

"Our research has shown that any stone larger than 4 millimeters in size will likely have to be removed surgically," Pope said. "Most children are simply not going to pass a stone that large."