Question

A 40-year-old man develops severe back and abdominal pain after dinner. The pain subsides during the night but recurs in the morning, and he visits his family physician. Results of a complete blood count and an amylase are normal. Results of a routine urinalysis are as follows:

Color: DARK YELLOW

Clarity: HAZY     

SP. Gravity: 1.030

pH: 5.0

Protein: TRACE

Glucose: NEG

Ketones: NEG

Blood: MODERATE

Bilirubin: NEG

Urobilinogen: NORMAL

Nitrite: NEG

Leukocyte: NEG

Microscopic:

15-20 RBCS

0-2 WBC

EPITHELIAL CELLS

a. What condition could these urinalysis results and the patient’s symptoms represent?

A) Cystitis

B) Renal lithiasis .

C) Bladder carcinoma

D) Acute pyelonephritis

b. What would account for the crenated RBCs?

A) Catheter damage

B) Glomerular bleeding

C) High specific gravity

D) Septicemia

c. Is there a correlation between the urine color and specific gravity and the patient’s symptoms?

A) Yes

B) No

d. Based on the primary substance that causes this condition, what type of crystals might have been present?

A) Triple phosphate

B) Uric acid

C) Ammonium biurate

D) Calcium oxalate

e. What changes will the patient be advised to make in his lifestyle to prevent future occurrences?

A) Decrease strenuous exercise in hot weather.

B) Increase water consumption.

C) Decrease consumption of dairy products.

D) All of the above

Answer 1

A) The presence of hematuria and the episodic nature of the pain represent kidney stones ( renal lithiasis).

B) Glomerular bleeding

C)Yes there is a correlation.

The stones damage the walls leading to hematuria ( dark yellow colour), and increased specific gravity of the urine.

D) Calcium oxalate stones are the most common form of stones.

E)All should be done.

Increased strenuous activity in hot weather leads to dehydration which leads to difficulty in passing the stones.