Like many teenagers, Claire didn’t think much of kidney stones or how they formed. That is, until she had one herself and experienced the pain firsthand. Following successful stone surgery, she now embraces better eating and drinking habits, and encourages others her age to do the same.
Chocolate, peanut butter, coffee and tea. Strawberries and even some leafy greens.
This is just a sampling of some of the foods 15-year-old Claire Monti now avoids, for the most part, as she embraces a new diet following surgery to remove kidney stones.
“Chocolate is so hard [to avoid]. And peanut butter too,” admitted Claire. “It’s hard but I don’t want another kidney stone. So I’m willing to do whatever I need to do to not get one again.”
Like most teenagers who have had stones, it took Claire a few days to fully embrace the idea of a new diet. Change can be difficult for teens, according to registered dietitian Chrisy O’Connor, who works in Nutrition Therapy. But she’s been very encouraged while working with Claire and her mom, Theresa, in clinic.
“I was impressed with both Claire and her mom because they were very in tune with what was needed. They were amazed by how much a diet can effect stones in general,” said O’Connor. “Teens basically don’t have a well-balanced diet to begin with. The biggest concern is making sure they are getting enough fluids each day.”
Avoiding Kidney Stones
Claire now carries a water bottle with her all day at school and drinks lemonade regularly. In her case, she developed calcium oxalate kidney stones, which form in the large intestine when calcium from your diet combines with oxalate salts. Made primarily in the liver, oxalate is also found in several foods (chocolate, etc.). So in addition to drinking plenty of fluids (water and lemonade) and regular exercise, Claire has also changed her eating habits and limits oxalates to 40-50 mg a day.
According to urologist William DeFoor, MD, MPH, who performed Claire’s surgery, pediatric kidney stones were relatively rare just 15 years ago. Today, the Stone Center sees new patients almost daily. In addition to dehydration, a high salt diet can be a risk factor for calcium based kidney stones. The sodium in table salt causes more calcium to be pumped into the urine by the kidneys which then clumps together to form stones.
“We try to educate people to read labels,” he said. “Anything processed or canned, it’s very difficult with our western diet to slow down sodium intake.”
Difficult, but not impossible, as both Claire and Theresa want to avoid surgery for another stone. They’re grateful for the dietary advice and the Stone Center’s proximity to their home in Montgomery, Ohio, just 20 minutes north of Cincinnati.
Monthly clinics also were established three years ago to help meet the increased demand. Given that 50 percent of kids with stones will have future stones, the center emphasizes patient education and identifying risk factors for recurrence.
Proactive educational efforts have been effective over the years as the number of patients requiring surgical producers and emergency department visits has decreased significantly after enrolling patients in the Stone Center, according to DeFoor.
“I had no idea it even existed at all,” said Theresa. “Of course I know about Cincinnati Children’s and the great reputation, but I didn’t know about the Stone Center. We’ve had a very good experience.”
Surgery and Follow-up
It all began a few months ago when Claire’s complaints of “continuous stabbing pains” prompted a trip to the Liberty Campus emergency department, where she was examined and sent home with medicine to help the stone pass. The stone didn’t pass naturally, however, and as the pain increased over the next few days they went directly to the Burnet Campus ED.
Claire underwent surgery that afternoon. The stone, however, was severely impacted. It was wedged into the drainage tube to her bladder and Dr. DeFoor was unable to remove it. Instead, he put in a stent – a tiny plastic tube – to allow the kidney time to recover. Less than a week later he was able to break down the stone and remove the fragments and the stent.
Claire’s follow-up appointment a couple of months later included a full round of testing and metabolic workup to determine how the stones formed and how to prevent a recurrence. Claire’s individual data was collected and she and her mom met with Stone Center staff, as well as a nephrologist and dietitian, to discuss next steps.
New imaging results showed that the kidney obstruction had resolved and no additional stones were evident. The prescription: a new diet, potassium citrate supplements twice daily and increased hydration.
“Not everybody has to restrict sodium in their diet, but if you are prone to have [stones] – family history, or if you had them in the past – it’s very motivating once you’ve had a stent placed and surgery done to not want to go through that again. That’s when dietary restrictions usually stick better,” said DeFoor.
It’s not just dietary restrictions, either. Eating foods with calcium is another important part of Claire’s diet. Eating an adequate amount of foods with calcium helps the oxalates bind to the calcium and prevent stones from forming. And citric acid in lemonade helps prevent calcium crystals from lumping together and forming stones.
“I eat a lot of yogurt now. And cheese sticks. And lemonade. The citrate in the lemonade is important. I drink it every day,” said Claire.
Another near daily occurrence? Claire finds herself talking with family and friends about the benefits of hydration and healthy eating.
“I tell my friends, ‘Remember when I wasn’t at school for two weeks?’ I remind them how much pain I was in. I tend to scare them into drinking more water.”