The incidence of pediatric nephrolithiasis, or kidney stones, is increasing between 6 to 10 percent a year, driven in part by obesity and poor diets. To counter this rise, pediatric urologist Pankaj Dangle, M.D., an assistant professor and director of robotic surgery in the division pediatric urology at the University of Alabama at Birmingham (UAB), spearheaded the effort to establish a multidisciplinary pediatric kidney stone clinic at Children’s of Alabama.
The clinic, the only one of its kind Southeast, is a collaboration among Dangle, pediatric nephrologist Michael E. Seifert, M.D., an associate professor in the division of pediatric nephrology at the University of Alabama at Birmingham (UAB), and Children’s clinical nutritionist Perrin Tamblyn Bickert, MS, RD, LDN, CLC, to provide coordinated care for the prevention of kidney stones. Patient visits are coordinated through the urology specialty care clinic at Children’s.
Seifert, who treated many of these children while training in Boston, knew he wanted to find a better way of managing children with kidney stones and preventing their recurrence.
“One reason we started the clinic is that kidney stones are typically identified in the acute stage, when children present to the emergency department,” Seifert said. Patients usually see a urologist who determines whether to handle the stone medically or surgically. “But that doesn’t do anything about preventing future stones,” Seifert said. And, given that a child who develops a kidney stone has a 50 percent chance of developing another stone in the next 12 to 18 months, “just getting rid of it is only part of the story.”
With the clinic approach, Seifert said, children can see three specialists during one visit, and the clinicians can talk to the patient and family together to develop a comprehensive treatment plan focused on prevention of future kidney stones. “To have an all-in-one clinic at the same time makes this a novel clinic and a great resource for kids,” he said.
“The most important thing is that we are now able to provide comprehensive care to our patients so that all aspects of the disease are addressed,” said Dangle, who, prior to joining UAB/Children’s, treated children while training in Chicago. “The urologist deals with it surgically; then the nephrologist assesses blood serum levels of minerals and vitamin D, how well their kidneys function and obtains a 24-hour urine analysis.” After that, Bickert enters the picture and calculates the nutritional formula.
“When all three of us are in the room at the same time, it reinforces what each of us are saying,” Dangle said.
Nutrition and inadequate hydration play a major role in kidney stone development, which is why the nutritional part of the management plan is so important, said Bickert, who is one of only two pediatric renal nutritionists in the state. She works with children and their families to modify the amount of sodium in their diet, increase fluids and limit oxalate intake. “We ask kids to participate as much as possible,” she said.
Bickert’s job can be challenging, she admits, particularly since she may be asking families to change long-entrenched eating habits. “A lot of our patients live off chicken fingers and French fries,” she said. Both are salty, and potatoes are very high in oxalate, which contributes to stone development. “So reducing sodium intake after years of a high-sodium diet can be a very big lifestyle adjustment.” Bickert also works with schools to ensure that children can carry a water bottle with them. The schools send her their lunch menus in advance, and she circles the items her patients can eat.
“We know that prevention is better than any cure in medicine,” Dangle said. “And the clinic is helping us with that.”
 Miah T, Kamat D. Pediatric Nephrolithiasis: A Review. Pediatr Ann. 2017 Jun 1;46(6):e242-e244.
Learn more about nephrology clinics and services at Children’s of Alabama.