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Launching of UK HealthCare's Kidney Stone Clinic

Dr. Aftab Chishti, the Director of Clinical Services at UK HealthCare's Division of Nephrology, Hypertension & Renal Transplantation and Dr. Campbell Grant, a Pediatric Urologist at UK HealthCare, join us to discuss kidney stones in children and the launching of UK HealthCare's Kidney Stone Clinic.

Launching of UK HealthCare's Kidney Stone Clinic
Featured Speakers:
Campbell Grant, MD | Aftab Chishti, MD, FASN, FAAP, CCST
I grew up in Louisville, Kentucky, across the street from a urologist, which is how I got involved in the field. I completed my medical school at the University of Kentucky in 2014 and went to George Washington University in DC where I finished my urology residency in 2019. 

Learn more about Campbell Grant, MD 

Aftab Chishti, MD, FASN, FAAP, CCST is the Director of Clinical Services, UK HealthCare Division of Nephrology, Hypertension & Renal Transplantation. 

Learn more about Aftab Chishti, MD
Transcription:
Launching of UK HealthCare's Kidney Stone Clinic

Scott Webb (Host): Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm Scott Webb. And today we're discussing kidney stones in our children and how the multidisciplinary team at Kentucky Children's Hospital Kidney Stone Clinic can help. And I'm joined today by Dr. Aftab Chishti, he's the Director of Clinical Services, UK Healthcare Division of Nephrology, Hypertension, and Renal Transplantation. And I'm also joined by Dr. Campbell Grant. He's a Pediatric Urologist. So first off want to thank you both for being here. This is going to be an interesting conversation, essentially about kidney stones and treatment, and what we can do to help children who may be suffering from kidney stones. As we get rolling here, Dr. Chishti let's have a little baseline. What is a kidney stone exactly?

Aftab Chishti, MD, FASN, FAAP, CCST (Guest): Kidney stones are basically some huge, large deposits of minerals and salts that are formed inside your urinary tract, anywhere from within the kidney, down to the bladder and sometime into the outer passage of the urine as well. They are also called renal calculi or nephrolithiasis, which is a Latin complex word, or urolithiasis.

Host: So Dr. Grant, what are the signs and symptoms that our children may be suffering from kidney stones?

Campbell Grant, MD (Guest): Obviously kids sometimes may have a harder time giving symptoms as adults, but usually the main reason that most children present is because of pain, from a kidney stone that is blocking the outflow of urine from the kidney. That pain usually starts in the back or the flank, but it can also be in the belly or even go down towards the pelvis and near the bladder. It's usually accompanied by nausea or vomiting as well. Some of our patients feel like they need to go to the bathroom all the time, depending on where the kidney stone is. Or sometimes they'll say that it hurts to pee. And I have seen patients too, where sometimes the first symptom that causes them to present to us is blood in their urine. But usually most of the time we see patients with kidney stones because they're having pain.

Host: Yeah, it does seem like pain is the, number one indicator and, you know, should we take the time to schedule an appointment? So let's just say our child, you know, is exhibiting or telling us about some of these symptoms pain and so on. Should we take the time to schedule an appointment or would it be best to just go right to the emergency department?

Dr. Grant: So if your child is having severe pain, you should take them to the emergency department. I feel like that's the easiest thing for most parents, and it's probably the best way to get them treatment in the acute period where they're having that pain. If your child's only symptom is blood in the urine, you can consider making an appointment with your primary care physician, to get further workup for that. But most of our referrals for kidney stones come from patients who originally presented to the emergency department.

Host: Yeah. And as a parent, who's had to take both of my kids for sports injuries and things like that to the emergency department. Sometimes it just seems easier that way. It's like, you know what? They can do everything there. Let's just go there and we'll see how things go.

So yeah. Dr. Chishti, back to you, is there anything we can do to prevent kidney stones, to help our children not get kidney stones and if our children have recurring stones, is that the sign of a bigger problem and greater reason for concern?

Dr. Chishti: First and foremost, I would say that you have to have established diagnosis. Once you have confirmed that the kid has kidney stone, then certainly a lot can be done to prevent kidney stones. My pet peeve, and what I have always been taught is a sentence that I will have used for every patient of mine, which is solution to pollution is dilution, which is poetic, but all it means is drink, drink, and drink. The best thing we can do to prevent kidney stone is to drink enough water. Adult and kids alike, we all don't drink enough water. So, if we drink about, depending on the child's size liter, liter and a half of water, in addition to other fluids, I think we can prevent a lot of kidney stones, but obviously that doesn't work for all.

Oh, as your second question was that if it keeps happening again, you had one, six months ago, then you have one today and a couple of months later, you are having symptoms again. Then there definitely is an underlying potential problem, which could be genetic. There are people who have genetic predisposition for kidney stones, or it could very well be your diet because in this day and age, we eat more protein than we should. We eat less vegetables and fruits than we should. So we should encourage a balanced diet to prevent kidney stones as well. But recurring stone definitely needs a comprehensive evaluation.

Host: Yeah, that sounds right. And Dr. Grant you know, when we think about treatment options, what's the latest and greatest, what's the gold standard and what are you excited about?

Dr. Grant: Sure. So there are definitely a number of different ways that you can treat kidney stones. And a lot of it depends on the size and the location. So most patients that present the emergency room with pain have a stone that's obstructing their ureter, which is the tube that runs between the kidney and the bladder. A lot of times in the sort of short-term scenario or to try and treat these acutely, what we'll do is go in with a really small telescope, through the patient's urethra, no incisions and break up the stone with a small laser and pull out the stone pieces. It can be great, obviously because it's no incisions, but the downside is sometimes it takes multiple procedures because kids are so small that you have to place a temporary stent to help the urine get passed and to make the ureter a little larger.

There are a couple of other treatment options as well. In cases where pain is not as sharp or there's stones that are up in the kidney that needed to be broken up, there's something called shockwave lithotripsy, where we use little ultrasound waves to break the stone up into small pieces to allow the stone to pass on its own.

And that's great too. Another thing with no incisions. And then, if in the case of large kidney stones, sometimes we have to make an incision in the back and put our telescope in, through a small incision in the back. But that's usually reserved for patients who have very large kidney stones, that can't be treated like with our small scopes.

Host: Yeah. And I'm guessing if it puts a smile on my face, I'm guessing kids love to hear about lasers and shock waves. And, Kentucky Children's Hospital Kidney Sone Clinic uses a great multidisciplinary approach to care for children with recurrent issues when it comes to kidney stones. So, let's talk about the team. Who's on the team and how's it beneficial to have this multidisciplinary approach to care?

Dr. Grant: So our team includes, pediatric urology, which is myself, our two nephrologists, Dr. Chishti and Dr. Kiessling, a dietician. We have nurses and social workers as well. And the big benefits of the multidisciplinary approach is it allows all of us to work together, to come up with a coordinated treatment plan that's individualized to every kid. It eliminates the need for multiple appointments in different buildings. We can usually do everything on one day between imaging and appointments, and it just sort of streamlines everything. You know, we have a lot of families who are coming from several hours away and so trying to get all that stuff coordinated as much as possible can be, you know, a godsend for them.

And the other reason that sort of is beneficial, is that because we're kind of talking and coordinating this care, you know, it helps to keep patients from reoccurring. Most children with kidney stones have about a 50% chance of having a repeat stone episode within the three years. And so by all of us working together, we hope prevent kids from having those repeat events as best we can.

Host: Yeah, as you say, folks are coming from greater distances and we want to sort of get as much done as we can and make the most of those trips, which sounds really good and that great multidisciplinary approach. And Dr. Chishti, why choose Kentucky Children's Hospital for care for Pediatric Kidney Stone issues?

Dr. Chishti: Kentucky Children's Hospital provides a comprehensive general pediatric care and also provides with our multidisciplinary clinic. It gives an opportunity to have everything under one roof, both because kidney stones are treated everywhere in a multidisciplinary fashion. You don't need only surgery. You don't need only medical management, which is adjustment of your diet and maybe extra medications. So when you come to a Stone Center, you get all under one roof. The dietician is there. Medical management, pediatric nephrologists are there. And, surgical team is always available. I think we have developed a very strong team and it is up to date and with all the advances in kidney stone management. So, those are pluses that families get coming to Kentucky Children, and we want to provide the best care for the children of Commonwealth.

Host: Yeah, which is of course, is music to my ears, to parents' ears. And it sounds like a lot of good reasons, a lot of great reasons to go to Kentucky Children's Hospital for kidney stone issues or anything else really that's affecting our children. Dr. Grant, no pressure here, but last word to you when it comes to kidney stones, children, treatment and so on.

Dr. Grant: So kidney stones have become a much bigger problem in children over the past few years. We're seeing more and more of them in kids. And that means that we need to come up with better treatment algorithms and better ways to treat kids. And we here at Kentucky Children's believe that this multidisciplinary approach is the best way to keep kids healthy and to keep them from needing our care in the future.

Host: Yeah, I think you're so right. And of course we, as parents, we all want the best for our kids. So great to hear about this today. Thank you both. And you both stay well.

Dr. Grant: Thanks Scott.

Dr. Chishti: Have a good day.

Host: Please visit our website for more information at ukhealthcare.uky.edu. And that wraps up another episode of UK HealthCast from the University of Kentucky Healthcare. Please remember to subscribe, rate and review this podcast and all of the other University of Kentucky Healthcare podcasts. I'm Scott Webb. Stay well.