Ep. 132 Metabolic Workup for Pediatric Stone Patients with Dr. David Sas

This week on BackTable Urology, Dr. Jose Silva and Dr. David Sas, a pediatric nephrologist at the Mayo Clinic-Rochester, discuss clinical presentation and prevention of kidney stones in children as well as workup of metabolic diseases. --- SHOW NOTES First, David explains how laboratory and genetic tests can be useful when determining the cause of kidney stones. Obtaining a 24-hour urine sample and analyzing stone composition are important for understanding the causes of stone formation in teenagers. Environmental and genetic factors can also contribute to the formation of stones. For example, CYP24A1 mutation a gene can cause a hypersensitivity to vitamin D and calcium in the diet. Next, David and Jose discuss lifestyle modifications for preventing stones in teenagers. They talk about how to limit sodium intake, the use of thiazide diuretics, and supplementing potassium citrate for calcium oxalate stones. Furthermore, they delve into the causes of hyperoxaluria, which are genetic primary hyperoxaluria and enteric hyperoxaluria. Additionally, they discuss the rare monosodium urate stones, which are usually associated with metabolic acidosis but can be caused by chronic diarrhea or eating a lot of protein. The doctors end by discussing the challenges of transitioning pediatric management to adult management. Lastly, they discuss the potential causes of why more kids are forming stones, such as increasing sweet juices and fast food in the diet.