CASE ANALYSIS

GROUP 7 MT3D

THE CASE
An obese patient presented with the following symptoms:
Severe pain in the side and back,
Pain during urination,
Persistent need to urinate but in small amounts of urine.
He also told the doctor that his urine seems reddish.
Imaging test reveal that the patient has kidney stones. The patient went through
surgery to remove the kidney stones. The stones were then sent to the
laboratory for analysis. The stone appears to be dark in color and very hard with
rough surface. Upon chemical examination, test results show that the stone is
made up of calcium oxalate.

PERTINENT INFORMATION
Patient as stated is obese.
Approximately 50% of the oxalate typically present in urine is derived
from ascorbic acid (vitamin C), an oxalate precursor or from oxalic acid.
Foodstuffs high in oxalic acid or ascorbic acid include vegetables (rhubarb,
tomatoes, asparagus, spinach) and citrus fruits. In addition, beverages that
are high in oxalic acid include cocoa, tea, coffee, and chocolate.
As urine forms in the renal tubules, oxalate ions associate with calcium
ions to become calcium oxalate. When conditions are optimal, calcium
oxalate can precipitate in a crystalline form.

 Calcium calculi are frequently associated with metabolic calcium

and phosphate disorders and occasionally diet.
Small calculi may be passed in the urine, subjecting the patient
to severe pain radiating from the lower back to the legs.

GUIDE QUESTIONS

1. What chemical examination is

done to identify the composition of
the kidney stone in this case?

 The calcium oxalate examination is done to identify the composition of

the kidney stone.
This is a test to see whether you have a high level of the chemical
oxalate found in the kidney stone.

2. What are the different tests

included in kidney stone analysis?
Describe each briefly.

3. Enumerate and describe the

different possible compositions of
kidney stones.

PATHOPHYSIOLOGY
Kidney stone formation may result when the urine becomes overly concentrated with
certain substances. These substances in the urine may complex to form small crystals and
subsequently stones.
Stones may not produce symptoms until they begin to move down the ureter, causing
pain . The pain is severe and often starts in the flank region and moves down to the groin.
The size of the renal stone will dictate the natural history of this condition.If the stone is
less the 5mm in diameter, then it will most likely pass on future urination. If the stone is
larger than 5mm, urological procedures may be required to remove the stone. Surgical
intervention will be required in any patient whose urinary tract in completely obstructed.
This situations represents a surgical emergency.

REFERENCES:
Urinalysis and Body Fluids by Strasinger, Susan King, Di Lorenzo,
Marjorie Scaub
Henrys Clinical Diagnosis and Management by Laboratory Methods
page 475