Question

A 28years old man visits the clinic complaining of an intense, sharp pain in his back and side .the patient confesses to eating a diet high in Animal proteins such as meat, cheese and fish. results of the urine analysis are shown below. cuss or discuss.

color:yellow Glucose: Negative Urobilinogen: normal

Appearance:clear protein: trace  Blood:large

specific gravity:1.025. Ketones:150mg/dl Nitrate:Negative

pH:5.0 Bilirubin: Negative Leukocyte:Negative

MICROSCOPIC ANALYSIS : 0-3wbc/hpf 20-30bacteria/hpf 0-5 squamous Epithelia cells/hpf. with an unidentified crystals.

Answer 1

Interpretation of the lab values

Color:yellow ( Normal color : Pale yellow to Amber in color)

Hence the color of the urine looks normal.

Glucose: Negative (Normal Range - 0 to 0.8mmol/L)

It indicates the patient is not having the history of Diabetes mellitus.

Urobilinogen: normal (Which indicate the patient is having the normal liver function)

Appearance: clear ( Normal)

Protein: trace (Trace amount of protein in urine may indicate some alteration in the kidney function or due to some other secondary causes). It may be due to kidney dysfunction such as Nephrotic syndrome or pyelonephritis)

Blood:large ( Hematuria may or may not due to specific reasons but it may be due to some dysfunction in the kidney such as Bladder infection( Cystitis), Kidney infection ( Pyelonephritis), Kidney Stones.

specific gravity:1.025. (Normal range between1.002 to 1.030) Hence Specific gravity of the urine looks in normal range.

Ketones:150mg/dl ( Less than 250mg/dl) is in normal range.

Nitrate:Negative ( No presence of Nitrate in urine, which indicates absence of infection in the kidney)

pH:5.0 9 ( Normal range 4.5 to 8 ), It shows that the urine ph is slightly acidic.

Bilirubin: Negative (Which reveals No liver dysfunction )

Leukocyte: Negative ( Normally trace amount of Leucocyte will be there in urine which indicate the presence of infection )

MICROSCOPIC ANALYSIS: 0-3wbc/hpf 20-30bacteria/hpf 0-5 squamous Epithelia cells/hpf. with an unidentified crystals.

Impression and findings

From the interpretation of the above finding the client can be provisionally diagnosed as Cystine stones.

Because the client had a history of pain over the back and side, presence of blood in the urine, And a meat eater, Cystine is present abundantly in meat

Cystine Stones

It is termed as cystinuria, it is due to the leakage of cysteine in urine

When there is too much of cysteine in urine can leads to cysteine stones, Which get obstructed anywhere in the urinary tract.

Risk Factors:

• Genetic ( inherited genes from both the parents)

Symptoms

• Pain during urinating
• Nausea and vomiting
• Blood in urine
• Sharp pain in the side or back
• Pain over the groin, abdomen or Pelvis

Treatment and prevention

1. Water- Drinking larger amounts of water will reduce the ability of the cysteine to convert into stones.

2. Salt – Reducing the intake of salt can reduce the cysteine stones from forming, Advice the client to avoid Packed and processed food items and meats

3. Diet – Cystine stones were formed if the urine is more acidic, Eat more fruits and vegetables to reduce the acidic nature of the urine, Avoid eating meat which increase the risk of cysteine stones.

Surgical Procedures

If the stone is too large, It will get blocked in the urinary tract which can be treated by the following procedures.

Nephrolithotomy

Ureteroscopy

ESWL ( Extra corporeal shock wave lithotripsy)