It’s often surprising for parents to learn that their child has a kidney stone, a painful condition that is more common in adults but has dramatically increased in prevalence among pediatric patients over the last 25 years. Seeing this trend firsthand as a pediatric urologist and epidemiologist at The Children’s Hospital of Philadelphia, Gregory E. Tasian, MD, MSc, MSCE, realized that more research about pediatric kidney stone disease was desperately needed.
“The fact that there has been very little prior research has led to a lot of uncertainty about how to provide the best care for these children, both surgical management and prevention strategies,” said Dr. Tasian, who also is an assistant professor at the Perelman School of Medicine at the University of Pennsylvania. “Kidney stone disease is an important area of research and is exciting to study because so much is changing in the incidence and prevalence of the disease.”
Dr. Tasian’s epidemiological findings published in Environmental Health Perspectives gained attention for suggesting that rising temperatures due to climate change could offer a possible explanation for why kidney stones may increase in the future for individuals who are predisposed to the condition. In recognition of this novel insight, Dr. Tasian recently received the 2016 Young Physician-Scientist Award at a joint meeting of the Association of American Physicians, the American Society for Clinical Investigation, and the American Physician Scientists Association held in Chicago.
Dr. Tasian presented meeting attendees with highlights from the 2014 study, which showed that the delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days. Sizzling temps could contribute to dehydration, which leads to a higher concentration of calcium and other minerals in the urine that promote the formation of kidney stones.
Kidney stones may grow over time, be washed out of the kidney by urine flow, and end up trapped within the ureter. Stones usually begin causing symptoms, such as pain in the sides, abdomen, or groin area, when they block the outflow of urine from the kidney to the bladder. About half of patients who are diagnosed with a kidney stone will have a recurrence within five to 10 years.
“The goal of my research is ultimately to lead to personalized, targeted interventions to increase fluid intake and decrease the risk of recurrence,” Dr. Tasian said. “If we can identify those periods of risk, then we also can identify interventions to offset that risk.”
Based on the preliminary results, Dr. Tasian is extending this research by comparing two methods of measuring temperature exposure. Dry bulb temperature, commonly known as air temperature, is indicated by a thermometer not affected by the moisture of the air. Wet bulb temperature incorporates both humidity and air temperature into one unit of measurement. Most of the research focusing on kidney stones so far has relied on dry bulb temperature alone, but Dr. Tasian wants to find out if wet bulb temperature could be a more accurate way to predict future stone prevalence.
Another line of research that Dr. Tasian is pursuing involves dietary determinants of kidney stones in children. Research studies with adult participants have suggested that high levels of fructose and salt could increase the chance of developing kidney stones, but the diets of children and adolescents can be much different than what their older family members consume. Dr. Tasian aims to identify certain dietary factors that may be contributing to why kidney stone disease is starting earlier in life.
“Your risk of kidney stones is the intersection between the things you can’t change — genetics, age, sex — and the things you can change — like drinking more water and fluids to decrease dehydration and modifying your diet. More research will help us to understand how all those pieces come together and how we might be able to develop strategies to reduce the risk of reoccurrence.”
In order to help families understand the many factors that are unique to the diagnosis and treatment of children with kidney stones, the Pediatric Kidney Stone Center, a program within the Divisions of Urology and Nephrology at CHOP, is solely dedicated to the management of kidney stones and treats nearly 300 patients each year.
Read more about Dr. Tasian’s kidney stones research here.