In recent years, there has been a steep and steady increase in the incidence of kidney stones in the pediatric population. Based on this increase, Boston Children’s Hospital established a pediatric Kidney Stone Program in 2007 to help manage the influx.
Dr. Nelson: A few years ago, we’d see a new patient about once a month. Now our team sees new cases every week. We have four Kidney Stone Clinics each month: two in Boston, one in Waltham and one in Weymouth. We also have a new location at our North Dartmouth satellite where we hold clinic regularly.
What do you think is causing this increase?
Dr. Nelson: There may be a number of reasons. Children are getting less physical activity, which is contributing to an increased incidence of obesity. Obese people are more likely to get stones, although both obese and non-obese children and adults can get them. We don’t know if obesity itself causes stones, or if obesity is just a marker for other factors that cause stones. Diet is a factor, as many children eat too much salt and highly processed foods and don’t drink enough water. Stones form when there’s too much of the stone-forming material and not enough water in the urine, so dehydration is a major contributor. …Read More
“Are you doing more harm than good in terms of creating resistance?”
According to Caleb Nelson, MD, MPH director of Quality and Safety and attending urologist in the Department of Urology at Boston Children’s Hospital, this question often causes a pause or prompts reluctance to use the medication.
“From the pediatrician standpoint, it’s useful to know more about what happens when you treat these kids in terms of how the resistance patterns change – or don’t change, over time.”
A recent study titled “Antimicrobial Resistance and Urinary Tract Infection Recurrence” sought to further investigate the relationship of antibiotic use and antibiotic resistance among children with vesicoureteral reflux. The paper, published in Pediatrics by the American Academy of Pediatrics (AAP), shows that although resistance was more common among children on antibiotic prophylaxis, antibiotic resistance decreased the longer the children stayed on prophylaxis.
This surprising finding suggests that children who require extended prophylaxis may not be at as high a risk of resistant infection as commonly thought.