When 6-year-old Blakely Kopatz first saw blood in her urine in January, her mother didn’t know what to make of it.
Blakely had no other symptoms, other than a mild stomachache.
The thought that Blakely might have kidney stones did not cross her mother’s mind. She didn’t have the intense pain of a kidney stone that her mother, Angela Fisher, had experienced once as a young woman.
Over the next two months, Blakely was diagnosed with a urinary tract infection and strep throat after blood kept reappearing in her urine. Finally, after Fisher took Blakely to her pediatrician following a second emergency room visit, the doctor recommended the first-grader go to a nephrologist (kidney specialist) at Akron Children’s Hospital.
There, Blakely was diagnosed with kidney stones.
The day Blakely went to Children’s was also the first day of the hospital’s new Pediatric Kidney Stone Clinic, a monthly program that combines care from a nephrologist, urologist, nurse and dietician.
Akron Children’s opened Northeast Ohio’s first pediatric kidney stone clinic in April, said Dr. Shefali Mahesh, director of nephrology at the hospital as well as director of the clinic.
The prevalence of kidney stones in children and teens has increased five-fold from the late 1990s to the early 2000s and now accounts for 1 in 685 hospital admissions for children, Mahesh said. Many experts believe kidney stones are more common in kids today due to major dietary and environmental changes in the United States.
“Children drink much less water and milk than previous generations and consume more sodium through processed foods,” Mahesh said. “Kidney stones form when there are changes in the normal balance of water, salts, minerals and other substances found in urine.”
Many culprits
Diets high in fat, sugar and processed foods aren’t necessarily the only problematic ones.
Low-carbohydrate, high-protein and even vegan diets — increasingly popular for children and adults alike — also can put children and teens at higher risk for stones, said Natalie Lussier, a renal dietician at Children’s.
“I never think a child should be put on a gluten-free, paleo or vegan diet without the guidance of a dietician,” she said. “What’s good for adults is not always good for a child,” she said.
Unlike the intense pain that adults experience with a kidney stone, often children don’t have the same pain or aren’t able to explain it beyond nonspecific abdominal or back pain, vomiting or blood in the diaper or urine, Mahesh said.
“Infants often get chalked up to them being colicky when they could have a kidney stone,” she said.
For Fisher, it was a huge relief to finally discover her daughter’s mysterious condition was something treatable.
“I didn’t know what to expect. We had a 6-year-old with blood in her urine,” Fisher said. “Knowing she wasn’t in pain was crazy to me. I didn’t know if she had a good tolerance for pain or she didn’t have pain.”
The specialists in the new clinic at Children’s were able to work together to quickly come up with a plan to treat Blakely’s kidney stones. The girl’s urine was analyzed to determine that her stones were calcium oxalate, the most common type.
Kidney stones can range in size from small stones that pass in regular urine without the person knowing to large stones that may need shock wave lithotripsy treatment to break them up and stents that allow the fragments to pass. Severe cases may need more advanced surgery to remove the stones.
Tackling the problem
Dietary changes are the first approach, Mahesh said.
“We don’t want to jump to medications. Nothing is more important than how much water you drink,” she said.
In Blakely’s case, she had surgery to use a laser to break up a large stone, and doctors left a stent in to make sure the ureter, the duct between the kidney and the bladder, didn’t swell shut, which would cause pain, pediatric urologist Dr. Curtis Clark said.
Blakely underwent surgery this week to remove the stent and clean out any remaining stones.
Recurrent kidney stones put adults and children at risk for worsening kidney function, increased bone fractures and higher rates of cardiovascular disease, Mahesh said.
The type of kidney stone that someone develops will make a difference in the diet needed to avoid future stone formations.
Lots of water helps dilute the substances that may potentially form stones. Adding citrus fruits, which include citrate, a natural kidney-stone inhibitor, can help even more.
Blakely’s parents follow a paleo, gluten-free and dairy-free diet, but her mother said they weren’t strict with having her follow their diet. After consulting with Lussier, Fisher has reduced Blakely’s sodium intake. Her favorite snack was Uncrustables, her mom said.
“Rather than doing a lot of pre-made meals and frozen meals, we will cook on Sundays for a few days so everything is really fresh,” Fisher said. Blakely is also drinking a lot more water with lemon.
Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/betty