Bella Carroto – Kidney Stones

It certainly wasn’t on the mind of Loren Carroto when she brought her daughter Bella to see her pediatrician in 2009. The reason was blood in the four-year-old’s urine. Bella, a bright-eyed, athletic youngster, had spent a long time in the bouncy house at a birthday party that day. The doctor suspected a urinary tract infection, or perhaps just a little too much bouncing, and sent her home.

“They assumed it was a one-time issue,” Loren says.

But it wasn’t.

A month later, the blood came back. And again a few weeks later.

This time, it was “a massive amount of blood. I was sick to my stomach,” recalls Loren.

After more tests failed to find a cause, the pediatrician recommended referring Bella to UPMC Children’s Hospital of Pittsburgh for more extensive tests and treatment by a pediatric nephrologist.

Not the Stomach Flu

Tests revealed excess calcium in Bella’s urine, indicating that she was a risk for kidney stones. A CT scan confirmed the diagnosis.

“After Dr. Moritz talked to us, and explained about the condition, we thought back and realized that what what we’d thought was the stomach flu — fevers, vomiting and abdominal pain — had actually been kidney stone episodes,” Loren recalls. “At four years old, we had no idea it could be that.”

But it was. And it was aggravated by activity. “The more active she was, the more the stones would move around, and that would cause the blood.”

Dr. Moritz prescribed a low-salt diet for Bella, with increased fluid intake high citrate in order to prevent stone formation. After a few months trying diet-only treatment, it looked like medication might be needed as well, and Bella was prescribed Diuril, a diuretic often used to decrease the calcium in the urine. In Bella’s case, the drug helped decrease the amount of minerals building up in her kidneys.

We tend to think of kidney stones as an adult condition, occurring when mineral deposits build up in the kidneys and cause pain and bleeding. It’s not something you’d expect in a four-year-old child. But that is changing.

“Pediatric kidney stones are on the rise,” says Dr. Moritz, “It’s one of our more common referrals for children. Most people aren’t aware of it, but we’re seeing it very frequently.”

The Solution

“It was a miracle drug,” says Loren. “We gradually found the dosage that worked best for her.”

With the low-salt diet, Bella has not had one episode since. Nor has she passed a kidney stone, an event that is both painful and a dangerous contributor to developing future stones.

Today Bella is nine years old, a third grader whose favorite subject is math. Loren and Chad are helping her manage her condition every day, hoping that she will outgrow it. Managing it is a daily discipline of medication, hydration, and careful attention to diet aimed at minimizing the amount of salt in Bella’s system.

“Low sodium is a hard diet,” says Loren. “It’s amazing how much sodium there is in everything. We found out that even bottled water has salt in it.”

School cafeteria food is a problem, so Bella packs her own lunch, and has a bottle of lemon water with her at all times for hydration. Loren constantly monitors her daughter for any sign of a recurrence.

“Whenever she says she has a stomach ache, I go into panic mode. Is it the flu, or is it going to be another episode? You never know when it’s going to hit.”

Athletic and Energetic

With her kidney disease in check, Bella’s natural energy and talent gets full reign. She plays soccer with the Mon Valley United Firedancers, a 3-on-3 team that trains occasionally with the Pittsburgh Riverhounds. The Firedancers recently placed second in a nationwide tournament, held at Disney World in Florida, with Bella leading the attack. Loren was hovering over her daughter the whole time making sure she stayed hydrated.

“I’m panicked all the time,” she says, “but that’s my job.”

Athletic and energetic, Bella wants to go pro when she grows up, like her hero, soccer superstar Cristiano Ronaldo.

“I hope she does,” Loren says. “After all, she’s our one and only. She’s our princess.”