Medical professionals are noting a concerning escalation in kidney stone cases among children, with some experts implicating a familiar culprit: ultra-processed foods. Other health specialists attribute the increase to genetics, poor diet and insufficient water intake.
When American Annabelle Pleskoff was 15, she woke up before school one morning with severe pain radiating from her right side. At the hospital emergency room, doctors initially thought she had mild appendicitis and sent her home. Later, she received an unexpected diagnosis: kidney stones, typically an affliction of older adults.
Now 25, Pleskoff, who has endured more than 30 kidney stones, is part of a troubling trend in paediatric health.
“Every day, we see children presenting with kidney stones,” Zachary Zuniga, a paediatric urologist at Texas Children’s Hospital, told The Washington Post. Some return repeatedly to the emergency room, and while not all require surgery, others will be admitted and need antibiotics.
Some health experts predict the problem will worsen.
“Historically, stones were pretty much a disease of white, middle-aged men, but that’s changed dramatically over the past 30 years,” said Gregory Tasian, a paediatric urologist at Children’s Hospital of Philadelphia who has conducted research on kidney stones in children.
He said the disease affects adults and children in similar ways because the stones are often made of calcium oxalate, but the profile of paediatric and adult patients differs.
“They’re young. They’re healthy. They don’t generally have other comorbid conditions,” he added.
Treating stones in children can involve medical management and, in some cases, surgical intervention.
Physicians typically begin by managing pain with over-the-counter medications or prescription drugs that help dilate the ureter muscles, enabling the stone to pass from the ureter to the bladder.
A child experiencing kidney stones may need antibiotics if they develop a urinary tract infection, which can occur when stones obstruct urine flow. Antibiotics can also be prescribed to prevent infections after a stone removal procedure.
For larger stones or those causing significant pain, doctors turn to procedures such as ureteroscopy, which uses a small scope to enter the bladder and break up the stone directly, or shock wave lithotripsy, which breaks up the stone into smaller pieces making it easier to pass.
A 2016 study in the Clinical Journal of the American Society of Nephrology analysed kidney stone incidence among 15-to-19-year-olds in South Carolina from 1997 to 2012. Researchers found a 28% increase over a five-year period for girls. For boys, that increase was 23%.
Painful chronic conditions like kidney stones can profoundly disrupt the lives of teenagers and children, forcing them to confront challenges unfamiliar to many of their peers. Pleskoff’s struggle with stones significantly disrupted daily activities, preventing her from participating in swimming, a sport she loved.
To manage her condition, Pleskoff adhered to a strict diet designed for people beset with kidney stones. The diet became a central focus of her life, dictating her food choices and daily routine. But the pressure to maintain this restrictive diet led to anorexia, she said.
“Just the idea that if I restricted my diet, I wouldn’t be in as much pain, and then I ended up restricting a little too much and not eating enough to keep my body healthy.”
The combination of physical limitations, including recurrent back pain, and mental health struggles in some young patients highlights the often-overlooked effect chronic conditions can have.
Some research suggests that genetic predisposition may play a role, but experts say the increase more likely reflects dietary habits and lifestyle.
A North Carolina doctor detected a potential culprit: salt-laden diets. Sodium intake has increased significantly among children in the past few decades.
“There is so much added salt to the American diet today, and when the kidney is excreting the sodium, it pulls calcium with it and increases the risk of calcium-based stones,” said John Wiener, a paediatric urologist at Duke Health.
More than 90% of children aged six to 18 consume 3 300mg of sodium daily, far exceeding the 2 300 recommended by the Dietary Guidelines for Americans, which are updated every five years and published by the Departments of Agriculture and Health and Human Services.
Processed and fast foods are among the main sources of excess sodium. Because many processed foods are deficient in essential nutrients, they can disrupt the body’s mineral balance, affecting calcium and oxalate levels. These minerals are crucial in the formation of kidney stones.
Even when a normal amount of sodium is consumed daily, some people are more prone to kidney stones. Experts suggest that people with a family history of the condition are especially susceptible, but that could reflect shared environmental and lifestyle factors, according to Wiener.
Rare genetic causes can contribute to the formation of kidney stones in children.
“There are some well-defined genetic diseases that affect metabolism and can cause people to form stones, but that’s a very small proportion of Americans with stones,” Wiener said.
In some cases, a patient can be an outlier in the family. Hunter Beck, 21, from Pennsylvania, is the youngest of five children and when he developed his first kidney stone at 12, his diet and exercise were typical for a young adolescent.
“My family has no history of kidney stones, so we had no idea that was even a possibility,” Beck said.
Similar to Pleskoff, he found that experiencing kidney stones as a child compromised his life so much he had to quit school sports. He said he coped with at least 15 kidney stones from 12 until he was about 18, with three or four stones present when he received an ultrasound.
In the past few years, he has mitigated kidney stones by avoiding teas, energy drinks and sodium. He has taken daily water pills and potassium citrate, which decrease acid.
Understanding his condition, Beck said, required a learning curve about kidney stones.
“Everyone knows about them, but nobody knows anything about the actual specifics in kids,” Beck said.
The evidence available on how to best treat children, whether medical or surgical, is “very weak”, Tasian said. “We know little about why kidney stones occur at a younger age when they didn’t occur at that age 30 years ago.”
Another theory intriguing some scientists: the potential role of climate change in the increase in kidney stones. While research in that realm is in its infancy, some experts hypothesise that environmental factors influenced by climate change could be culpable in the rise in kidney stone cases among children.
Climate-related disruptions can lead to food insecurity, pushing families toward diets high in salt, sugar and processed foods. When combined with inadequate hydration, these dietary options significantly elevate the risk of kidney stone formation. As fresh, healthy food becomes less accessible because of food deserts and high cost, the likelihood of kidney stones in children rises.
David Sas, a pediatric nephrologist at the Mayo Clinic who studies kidney stones, said his research finds a link between kidney stones and urban heat islands – densely populated swatches in cities packed with buildings and extensive paved surfaces. They typically experience higher temperatures compared with suburban or rural regions.
This temperature difference is ignited by concrete and asphalt absorbing and retaining heat throughout the day, with the heat released slowly at night. In contrast, regions with abundant vegetation and open green spaces allow for more efficient heat dissipation, maintaining a cooler environment.
“Temperature, humidity plus diet equals stones,” Sas said.
The rising temperatures can cause dehydration, a well-documented risk factor for kidney stones, exacerbated by frequent heat waves driven by climate change.
Children are more susceptible to dehydration than adults, losing water more quickly through sweating. This increased fluid loss leads to a higher concentration of minerals in the urine, creating fertile ground for kidney stone formation.
With their heat-retaining infrastructure, cities create environments where dehydration and its consequent health issues become more prevalent. Sas said these health risks are poised to intensify as temperatures continue to rise.
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