For children, a painful trend - kidney stones - fast-food diet?

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For children, a painful trend

Doctors seeing more young patients with kidney stones; fast-food diet may

play part

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By Bor

Sun reporter

December 29, 2006

http://www.baltimoresun.com/news/health/bal-te.kidney29dec29,0,7029664.story

Doctors at s Hopkins and other medical institutions are beginning to

report a curious increase in children with kidney stones - another

possible consequence of America's dependence on processed foods.

Bad eating habits have already fueled twin epidemics of childhood obesity

and Type 2 diabetes. Although doctors have blamed fats and sugar for those

ills, they say the culprit in this case may be two other features of the

fast-food culture: too much salt and not enough water.

Though kidney stones remain uncommon among children, specialists who once

treated only a few cases a year are trying to figure out why they are now

seeing many times that number.

" Five years ago, we used to see maybe a handful of children a year, maybe

five or six, " said Dr. Yegappan Lakshmanan, a pediatric urologist at the

s Hopkins Children's Center. " Now, it's five or six a month. Some are

repeat patients, but it's definitely a trend. "

Kidney stones, once found almost exclusively in adults, are tiny mineral

deposits that can cause excruciating pain when they lodge in the urinary

tract.

Three years ago, Hopkins established a pediatric kidney stone clinic after

noticing an increase in cases. More recently, the Vanderbilt Children's

Hospital in Nashville, Tenn., opened a stone clinic, and the

Harvard-affiliated Children's Hospital in Boston is doing the same.

" We feel like we're seeing the same trend, " said Dr. Caleb , a

pediatric urologist at Harvard. " Whereas five or 10 years ago, you could

go several months between [cases], now we see a couple a week. "

Improved methods of diagnosing stones could be one reason for the sudden

uptick of cases. They might account for larger numbers of children with

stones too small to cause symptoms, doctors say, but not what many believe

is an increase in children who arrive doubled over in pain.

" In children, we think diet has an important part to play - a lot of fast

food with high salt content, " Lakshmanan said.

Eating too much salt causes people to excrete excessive amounts of

calcium, which can crystallize in the urine in the form of stones. That

problem, Lakshmanan said, is compounded by the tendency of children to

skimp on water, which in sufficient quantities can dilute the minerals

that cause stones to form.

" We tell people to drink a lot of fluids, to empty their bladders

frequently and not to take in a lot of salt, " said Dr. Neu, a

kidney specialist who, along with Lakshmanan, directs the Hopkins clinic.

The two are worried about schools that limit the number of times a child

can visit the bathroom. Though teachers might be trying to curb abuse of

bathroom privileges, they could inadvertently be playing a role in a

growing medical problem. Holding one's urine can cause stones to form, he

said.

Quantifying the problem is next to impossible because childhood kidney

stones have never been carefully tracked. They remain far less common than

in adults, who have a one in 10 lifetime chance of developing them. Those

who have suffered one bout have a 50 percent chance of experiencing

another in the next five years, Neu said.

Pediatricians have long known that certain congenital problems - including

blockages in the kidney or bladder - can cause stones to form.

Additionally, babies treated in intensive care units sometimes get

medications that can predispose them to stones.

Those factors produced a small caseload, but nothing like the numbers

doctors have seen more recently. Some asymptomatic children are diagnosed

after doctors find minute calcium crystals in urine tests. Scans then

confirm the presence of stones. But others appear first in the Hopkins

emergency room with pain that's unforgettably intense.

" They didn't come to us just because we were stone specialists, "

Lakshmanan said.

agrees that it's too soon to declare diet the chief culprit, but he

believes it's a leading candidate. At Harvard and Hopkins, dieticians are

not only advising families about healthful eating habits, but also

compiling dietary histories that could help solve the riddle.

" It does make sense that the fatter the country, the more stones you'll

see, " said. That doesn't necessarily mean that processed foods are

causing kidney stones, he said. Children with kidney stones are more

likely to be overweight than youngsters in years past - but youngsters in

general are heavier than they used to be.

Nonetheless, there's general agreement that too much salt and too little

water can lead to kidney stones. Similarly, panels convened recently by

the American Medical Association and the National Academies of Science

raised alarms about the salt content of the American diet.

" Keeping track of things like intake of salt and water is extremely

difficult, " said. " You go to grocery stores, and the intake of

high-salt processed foods is through the roof. "

Doctors recommend no more than one teaspoon of salt - or 2.4 grams of

sodium - per day, Neu said. But many Americans, and particularly children,

consume much more than that from processed foods. Those include smoked and

cured meats, canned foods, snacks such as potato chips and pretzels, and

most of the offerings in fast-food restaurants.

Youngsters should also drink 2 liters of water a day, doctors say.

Substituting soda pop can be counterproductive, since the high acid

content of soft drinks can cause calcium to leach out of bones.

More sensitive CT scans have made it easier for doctors to diagnose

stones, and treatment is also less complicated and painful.

While open surgery was once the leading treatment, doctors now can break

stones up with shock waves generated by a machine outside the body.

Another method involves threading a catheter to the blockage and

shattering the stones with a laser.

Sweitzer, who lives in northern Baltimore County, says it's

possible that her son 's kidney stones were triggered by the cancer

chemotherapy he received years ago. Indeed, medical literature shows that

the two are sometimes connected.

But Sweitzer, who has had seven children with her husband, Tom, said she's

trying to re-evaluate the family's " typically American " diet.

" It's not like we're hitting Mc's five times a week, " she said,

though she estimates that the family makes one trip to a fast-food

restaurant weekly - and consumes too many sodas and packaged foods.

Earlier this year, , who is 7 and in second grade, began

complaining of a intense pain in his hip, followed by painful and

incomplete urination.

To the family's great relief, tests performed by 's oncologist

showed that the cancer had not returned. Later, an X-ray revealed kidney

stones, which were apparently sending shooting pains to his hip. At

Hopkins, the stones were surgically removed, and is now free of

pain.

What caused 's stones remains a mystery, but his mother said

parents should pay attention to the dietary possibilities.

" We really need to watch what our kids are eating, " she said. " If we're

having this type of problem that's more than likely from diet, we need to

be careful. "

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