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Link obesity to kidney stones in children

Newswise – Urologists and nephrologists have long suspected that obesity increases the risk of kidney stones in children. This link is well established in adults, but demonstrating it in children has been more difficult.

Recently, researchers at Children’s Hospital Los Angeles took a new approach to more clearly examine this link. The team – led by S. Scott Sparks, MD, and Arthi Hannallah, MD – examined 221 children with kidney stones at Children’s Hospital Los Angeles from 2007 to 2021.

But instead of looking at pediatric patients as a whole, they grouped them by puberty status – before puberty, during puberty and after puberty – and compared their body mass indices to young people of the same age without kidney stones. .

The results were clear: healthy children with kidney stones who had reached or completed puberty were more likely to have a significantly higher body mass index (BMI) than children of the same age who did not. kidney stones.

Dr. Sparks, who co-directs the Comprehensive Stone Program at Children’s Hospital Los Angeles with nephrologist Nadine Khouzam, MD, presented the findings at the Society for Pediatric Urology’s fall meeting in December. Dr. Khouzam was also one of the authors of the article.

“These high BMIs are very similar to what we see in the adult population,” he says. “Adjusting for pubertal status, we were able to demonstrate a link that doctors had long suspected.”

The idea for the study design came from Dr. Hannallah, a second-year fellow in pediatric urology at Children’s Hospital Los Angeles.

“Part of the challenge in studying kidney stones has been that children are so diverse in age and developmental stage,” she says. “We hypothesized that we would find high BMI in patients with stones from the onset of puberty, and we did.”

In contrast, the study found that children with kidney stones who had not yet reached puberty did not have a significantly higher BMI than the control group.

Why? “It’s possible that stones in younger patients are more often caused by other medical conditions, such as spina bifida,” says Dr. Sparks. “It’s not true in all areas, but it can be a factor.”

The study only looked at otherwise healthy children with stones, not those who had stones caused by specific conditions.

Dr Sparks also presented a second paper from the team, which found that children with kidney stones were more likely to come from low socioeconomic status households.

More worryingly, patients from families living at or near the poverty line were much more likely to need surgery for their stones.

Even the types of stones differed by socio-economic status. Wealthier children tended to have calcium oxalate stones, while less well-off children had struvite stones, which are more commonly diet-related.

The group is currently studying the impacts of living in a “food desert” – with a lack of proximity to healthy food – on the risk of kidney stones in children.

“All of these studies go hand in hand,” says Dr. Sparks. “We can see that obesity is a risk factor for stones in children. And we know that lower socioeconomic status is associated with higher rates of obesity and obesity-related diseases. Stone disease is probably one such obesity-related condition in older children and adolescents, just as it is in adults.

Understanding these risk factors is important because kidney stones have increased in children over the past few decades. The Comprehensive Stone Program at Children’s Hospital Los Angeles opened in 2016 and is growing rapidly, more than doubling the number of patients.

The clinic takes a multidisciplinary approach, with patients able to see nephrologists and urologists, as well as a nutritionist and nurses.

“Having all these services in one place is what makes the center so special,” he says. “We’re really able to dig into each patient’s condition and provide more in-depth care.

“The surgery part is the easiest part,” he adds. “We can remove kidney stones if necessary. The challenge is to prevent recurrences. We strive to provide every child and every family with the education and care they need to prevent stone disease in the future. »