Kidney Stones: Risks, Prevention, and Management in Cerebral Palsy

Urolithiasis is a relatively common problem around the world. In neurologically impaired children and those with cerebral palsy, kidney stones represent an understudied and unique challenge. Children with cerebral palsy are at increased risk of kidney stones due to their limited mobility, associated hypercalciuria, and inability in some to self-regulate their water intake. Some children are exposed to antiepileptic medications that have lithogenic potential, while other children may be receiving a ketogenic diet to help control their epilepsy. Children with cerebral palsy presenting with kidney stones may be unable to verbalize their discomfort and do not have a typical clinical presentation of renal colic, which can cause a delay in the diagnosis and treatment. Conservative management includes analgesia, hydration, and medical expulsive therapy. Surgical treatment of kidney stones is considered for larger stones, patients with persistent pain, and presence of urinary tract infection or urinary tract obstruction. The prevention strategies for recurrence of kidney stones include dietary modification and ample fluid administration. In some cases, alkali therapy and administration of thiazide diuretics may also be helpful.