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Boston Children’s Hospital researchers are studying the rise in overall exposure to medical radiation, as well as the increase in the use of computed tomography (CT) scans on kids coming to hospitals with kidney stones (urolithiasis).
In one study, clinicians have found that in most cases ultrasound is as accurate as CT scan, without any radiation. For cases when CT scans are still needed, Boston Children’s radiologists have led the way in pioneering low-radiation CT scan techniques that reduce radiation exposure dramatically.
In another study, our researchers observed how much x-ray imaging was being used in the operating room during surgery to treat kidney stone. It was found that the radiation exposure during these cases was significant. In response, clinicians in the Kidney Stone Program developed a checklist that reduced radiation exposure levels during these procedures by up to 80 percent.
Based on these studies, clinicians advocate ultrasound for diagnosis, and they’ve instituted new protocols at the hospital to reduce radiation exposure when other studies or surgery is indicated.
Research continues to look at factors that contribute to formation of kidney stones in children, including medications and diet, and the value of certain common tests performed in children with kidney stones. Recently, our researchers found that in 20 percent of children who had at least one kidney stone, the cause of stone development can be detected by analyzing 30 different stone-causing genes in a blood or saliva samples. For some patients this already has consequences for treatment or prophylaxis of stone disease.
Recently, the discovery was made in our division that in 20% of children who had at least one kidney stone, the cause of stone development can be detected by analyzing 30 different stone-causing genes in a blood sample or saliva sample of the patient (Halbritter et al. JASN 26:543, 2015). For some patients this already has consequences for treatment or prophylaxis of stone disease (Braun et al cJASN, 2016).
If patients wish, they can be enrolled in a research study that aims at finding a genetic cause of disease at no cost, which will be successful in 15-20% of cases. If a causative gene mutation is detected, patients may elect to have this finding converted into an actionable clinical genetic report by applying ‘specific mutation confirmation’ at cost, which sometimes may be reimbursed by the patient’s health insurance.
In addition, we are a participating center in the Rare Kidney Stone Consortium, an international group of researchers interested in rare kidney stone disease diagnosis and treatment. These include primary hyperoxaluria, Dent disease, cystinuria, and APRT deficiency. Boston Children’s Hospital has experts in the care of children with these rare, inherited kidney stone disorders.
To learn more about this study or any of our research, contact us.
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