Question

Fred, a fit and healthy 44-year-old, was working outside one warm summer afternoon. When he returned home by the end of the day, his lower back felt sore and he felt nauseated. His wife made him dinner, but he was not hungry and chose to go to bed instead. Fred’s symptoms progressed, and soon he was rolling on the bed with excruciating pain. He said his back hurt as well as his stomach and groin area. The pain would ease off only to return a short while later, and when it did, Fred would begin to sweat and run to the bathroom to vomit. His wife became concerned and started the car. When his symptoms abated, she helped him into the car and rushed him to the hospital.

At the hospital, an abdominal radiograph showed the presence of renal calculi in Fred’s right ureter (urolithiasis). What is the mechanism of stone formation in the kidney? What is the role of citrate in the kidneys?

Why would the administration of calcium supplements be useful for a patient with calcium oxalate stones?

Hydronephrosis can be a complication of renal calculi. What is hydronephrosis? How does back pressure occur in a kidney, and what physiologic mechanism is responsible for nephron damage when back pressure is present?

What are some important patient education points would you discuss with this patient?

Answer 1

Mechanism of stone formation:

Kidney stones are formed by the mineral substance present in the body.These mineral particles are particularly calcium,sodium and oxalate.When it is getting deposited in excess amount the kidney try to excrete it in the urine.By the time these particles are become crystals and accumulate together and thus form as stones.These substances become excess in the body by taking foods rich in calcium and oxalate or by taking certain medications or by taking less water to the body hence it unable to dilute the stone by own body mechanism.

Role of citrate:

It is an alkaline. It is a  stone formation inhibitor.It increases the actions of inhibiting the stone formation by reducing the aggregation of calcium and oxalate.It is the role of the citrate in kidneys.

Calcium supplements are given to maintain the optimum level of calcium needed for the body.Usually patients with kidney stones starts to avoid especially calcium rich foods it leads to further health problems like osteoporosis and other conditions. to avoid this circumstances calcium supplements are prescribed.

Hydronephrosis is a renal disease condition.Here a obstruction or block can be present in the pathway of urine flow.So it obstructs the urine to excrete out.These waste particles that is urine continued to be collected and cause swelling of the kidneys.It can be in one side or in both side.

These accumulated urine and swelling in the renal part makes difficult to nephron to perform its work.Because the whole swollen part is made of millions of nephron.

Patient education points:

Take adequate fluids and water to the body.

Take recommended amount of dietary calcium and oxalate in foods.

Take calcium supplements if prescribed.

Periodically check the urine calcium and oxalate levels.

Follow up the medications.