A 6yoM is brought by his guardian for intermittent crying, c/o abd pain for the past two days; he has vomited 4times over the past 2days. He has had no fever and has never had anything like this before. At home his urine has been dark, and this morning, possibly bloody. He has no medical problems, was a FT baby and is UTD. Here he looks calm and his belly is soft, his GU exam is unconcerning. What’s going on?
Kidney stone.
More frequent in the pediatric population in the past 10years, add this to your differential for the colicky child. (The younger the child, the more difficult this diagnosis is to make.)
Unlike adults, the first stone in a child should prompt referral to a nephrologist (and a urologist). Also, in about 75% of kids w/stones, there is a metabolic problem.
Importantly 15% of kids w/stones will have a clean UA (no blood).
Initial test is sono. If no hydronephrosis or large stone, do a noncon CT.
Ref:
Jancin, B. More Kids Get Kidney Stones. ACEP News. March 2012 Vol. 31 No. 3. p12.
