Identifying and Mitigating Risk Factors for Dehydration-Mediated Nephrolithiasis in Adolescents

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 DESCRIPTION (provided by applicant): The candidate for this K23 Patient Oriented Research Career Development Award aims to become an international leader in pediatric nephrolithiasis research, with particular expertise in using innovative interventions to increase treatment adherence and decrease kidney stone recurrence among adolescents. The proposed mentored research and career development plan facilitates this career goal by identifying and mitigating risk factors for dehydration-mediated nephrolithiasis in adolescents. High and low ambient temperatures lead to dehydration and increase nephrolithiasis risk among adults, but the effect of temperature on stone risk in adolescents, who are particularly susceptible to temperature extremes, is unknown. Water is a cost-effective way to decrease kidney stone occurrence; however, despite dehydration being common among adolescents with stones, no studies have identified barriers to water intake or developed interventions to increase water intake in this population. Aim 1 will determine differences in the temperature thresholds associated with kidney stone presentation among adolescents and adults. Aim 2 will identify barriers to water intake among adolescents with kidney stones using real-time data gathered through mobile devices. Aim 3 will measure the immediate and sustained effect of mobile device hydration reminders on urine calcium oxalate supersaturation and urine volume in adolescents with calcium oxalate kidney stones. The candidate brings to this proposal experience as a pediatric urological surgeon at a large urban children's hospital and training in clinical epidemiology. An integral part of his career development will be continued relationship with an outstanding multidisciplinary mentoring team. The candidate's primary mentor is Susan Furth MD, PhD. Dr. Furth is an international expert in treatment adherence among children with chronic kidney disease and has an outstanding track-record of mentorship. Ron Keren MD, MPH, Douglas Wiebe PhD, and Janet Audrain-McGovern PhD, will serve as co-mentors in the areas of clinical trials, ecological momentary assessment of adolescent health, and biobehavioral determinants of adolescent health, respectively. An advisory panel will help guide the candidate's career development and will provide expertise in metabolic kidney stone disease, water access among adolescents, biostatistics, and using mobile games to improve health. The proposed research and training plan will expand the candidate's expertise in advanced statistical analysis, clinical trials, and applying technology to improve health, and will provide the candidate with the skills and experience necessary for a career as a successful independent researcher focused on investigating novel interventions to improve treatment adherence and decrease kidney stone recurrence among adolescents.