ReviewClinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis

- The incidence of pediatric nephrolithiasis is rising.
- Children/adolescents represent a unique patient population with higher risks from radiation exposure as compared to adults and high recurrence rate.
- Ultrasound is the first-line modality for diagnosing suspected nephrolithiasis in children.
- First line therapy for stable patients is most cases is observation/analgesics with alpha-blockers as MET.
- Surgical management of pediatric nephrolithiasis is similar to adults with ESWL and URS first-line for smaller stones and PCNL reserved for larger renal stone burden.
- Clinical effectiveness in children/adolescents with nephrolithiasis centers around ED pathways that limit CT imaging, adherence to ALARA principles and use of US during surgical procedures.
- Patient/Family education on the risks of repeat ionizing radiation exposures during follow up is essential.

The incidence of pediatric nephrolithiasis has risen over the past few decades leading to a growing public health burden. Children and adolescents represent a unique patient population secondary to their higher risks from radiation exposure as compared to adults, high risk of recurrence, and longer follow up time given their longer life expectancies. Ultrasound imaging is the first-line modality for diagnosing suspected nephrolithiasis in children. Although data is limited, the best evidence based medicine supports the use of alpha-blockers as first-line MET in children, especially when stones are small and in a more distal ureteral location. Surgical management of pediatric nephrolithiasis is similar to that in adults with ESWL and URS first-line for smaller stones and PCNL reserved for larger renal stone burden. Clinical effectiveness in minimizing risks in children and adolescents with nephrolithiasis centers around ED pathways that limit CT imaging, strict guidance to ALARA principles or use of US during surgical procedures, and education of both patients and families on the risks of repeat ionizing radiation exposures during follow up and acute colic events.