Stories about: Dr. Caleb Nelson

Tackling kidney stones: Q&A with Boston Children’s Kidney Stone Program co-directors

kidney-stones-in-childrenIn 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.

Caleb Nelson, MD, MPHBartley Cilento, MD, MPH, and Michelle Baum, MD, program co-directors, discuss why kidney stones are becoming more common in children. 

How has your patient volume grown?

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

Does antibiotic resistance change over time in children on prophylaxis? A new study says yes.

biofilm of  antibiotic resistant bacteria
Biofilm of antibiotic resistant bacteria (Shutterstock)

When treating children with a history of urinary tract infections (UTIs) and reflux, pediatricians and primary care staff treat their young patients with preventative antibiotics. Although antimicrobial prophylaxis has been proven effective in preventing recurrent UTI in children specifically with vesicoureteral reflux, the question caregivers often ask is:

“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.”

…Read More

Quick Note: Defining the connection between UTIs and antibiotic resistance

UTI_shutterstock_274849442 (2)

Urinary tract infections affect approximately 3 percent of children in the United States and account for more than 1 million visits to pediatricians’ offices every year.

Although antimicrobial prophylaxis has been proven effective in preventing recurrent UTI in children specifically with vesicoureteral reflux, there remains an increased antibiotic resistance in children treated with antibiotics.

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.

…Read More