Q: My 11 years old son had a kidney stone of 5 mm size near the urine bladder. The doctor told him to take more water as it would come out with urine. He said that there is no need of tablets, if he feels pain then take a pain killer, which he prescribed. But I came to know that kidney stones in people below 20 years of age is a big problem. If not treated well the patient will die in 30 to 35 years. The problem in young is because of some chemicals and it should be checked and treated. We consulted another doctor and the ultrasound scan showed another stone of 3 mm size inside the kidney. He gave some tablets and asks us to take an X-ray after 20 days. Regarding our doubts of the seriousness of stone in people below 20 years he said nothing and said it is a normal stone. Please advise.

A:Medical history of your child is suggestive of predisposition for a recurrent stone formation. Commonly, a child would complain of an abdominal/or flank pain, occasionally presenting with high grade fever related to urinary tract infection resulting from an obstructing stone but many times may remain asymptomatic before being incidentally diagnosed with a kidney stone. To find the cause of the stone formation, one would need to review the child’s history including family history of kidney stone formation, looking for any evidence of kidney/urinary tract structural anomalies predisposing to stone formation and most importantly, seeking any evidence of metabolic disorders. Metabolic disorders could result in an abnormal excretion of various mineral salts into the urine, which could lead to recurrent stone formation. Hence to exactly find the cause and type of stone being formed, your child would require extensive lab work-up including 24-hour urine studies to quantitify the amount of various minerals salts like calcium, oxalate, uric acid, phosphate and cystine. Also included in the evaluation would be blood tests to check for the levels of various minerals as stated above and if possible to undertake a chemical analysis of a passed kidney stone. All these would help to identify the stone composition and predisposing factors towards the stone formation and accordingly offer certain medication intervention intended to prevent recurrent stone formation. Lastly, daily intake of >1.5 litres of fluid and low salt diet are known to reduce the chances of recurrent stone formation. I would recommend an evaluation by an urologist for your child for the continued care for the recurrent stone formation.