Question

In patient with kidney stone with right renal calculi:

Case Report:

A 56-year-old male anatomy professor at a well-known university in North Hollywood was brought to the emergency room at the UCLA Ronald Reagan Medical Center. His chief complaint was right flank pain.

History of present Illness:

One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day.

One hour prior to admission, the patient developed severe right flank pain associated with nausea. His wife was brought him to the UCLA Ronald Reagan Medical Center. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1 to 10. On physical exam, patient had the following findings:

• Vital Signs BP: 140/90
• Heart rate: 110/minute
• Respiration rate: 15/minute patient was afebrile
• All exam findings for the head, neck, heart, lungs, and abdomen were normal.
• On examination of the back, patient had tenderness on the right flank upon palpation.
• On examination of the genitalia, there was no penile discharge.
• Note of a 1 x 1 cm tophus on right big toe.

The following diagnostic exams were ordered:

• CBC with WBC differential count
• Urinalysis
• Serum uric acid
• KUB x-ray
• MRI Scan abdominopelvic area

He was immediately injected by IV with a strong analgesic to relieve the pain.

Past Medical History:

• Diagnosed with gout one year prior to admission
• On medication with allopurinol
• No heart and lung disease
• No diabetes or hypertension

in this pictures shows the axial scan of the abdomen, what is the organ pointed to by the three arrows? Is there anything wrong with this organ? If you answered yes, please explain in detail. What is a possible complication in this patient and the possible effect on the function of this organ in the long term?

Exam Results UCLA Ronald Reagan Medical Center Exams Ordered CBC with WBC differential count Results CBC within normal limits with no leukocytosis nor anemia RBCs too numerous to count No pus cells (+) uric acid crystals Slightly elevated Urinalysis Serum uric acid KUB (kidney ureter bladder) plain x-ray (radiograph) Abdominal Coronal MRI scan Abdominal Axial MRI Scan

Answer 1

Organ pointed to by the three arrows is right kidney and ureter.

Right ureter shows some radioopaque substance inside it.The plain X Ray finding is not very clear in the picture but MRI shows a clear radioopaque calcified stone inside it. When used with other imaging studies, such as a renal ultrasonography ,MRI or, CT scanning, the plain film gives a better understanding of the characteristics of urinary stones and position of the stone and also the extent of damage of the tissue. This also helps surgery selection.Approx 85% of all upper urinary tract stones are radioopaque,

COMPLICATIONS

Most potentially dangerous effect of renal calculi or stone is the combination of urinary tract obstruction and upper urinary tract infection. Barring that Pyelonephritis, pyonephrosis, and urosepsis can occur. Early recognition and immediate surgical drainage are necessary in these situations

Usually recurrence rate for urinary calculi is 50% within 5 years and 70% or higher within 10 years,