Medical Nutrition Therapy for Pediatric Kidney Stone Prevention, Part Two.

Intended Audience: Pediatrics; Nephrology Outpatient Clinic; Children With Kidney Stones RENAL STONE DISEASE, or nephrolithiasis, is a major health concern associated with significant pain, morbidity, and medical cost. Recurrent nephrolithiasis can lead to chronic kidney disease, as well as increased risk of related conditions such as cardiovascular disease and fracture. The incidence of nephrolithiasis appears to be increasing among US children in recent decades. Moreover, the health and economic burden of nephrolithiasis may be heightened in children who have increased rates of metabolic abnormalities, resulting in recurrent nephrolithiasis, leading to increased risk for developing end-stage renal disease. The majority of children (up to 95%) with nephrolithiasis have at least one metabolic abnormality that will likely require a combination of dietary and pharmacological therapy. Most common metabolic abnormalities are hypercalciuria and hypocitraturia, either isolated or co-occurring; other metabolic abnormalities include hyperuricosuria, hyperoxaluria, and cystinuria. Although studies that focus on pediatric populations are scarce, extrapolations from adult research suggest that the increasing rates of nephrolithiasis are related to shifting dietary norms, such as the widespread consumption of processed and fast foods, diets high in sodium and animal protein, and the decline in the consumption of fruits, vegetables, and calcium-rich foods.