Question

A 63-year old African American male presents to the ER complaining of severe flank pain and cramping as well as recent onset of blood in his urine. His labs are notable for decreased PTH and increased calcium. What is the most likely cause of the flank pain? After 24 hours, the patient passes a kidney stone analysis of the stone would demonstrate what finding most likely? What condition is indicated by the decreased PTH and increased calcium levels? What is the negative feedback mechanism for PTH? What ares some of the risk factors for stone formation and what are possible treatments? Any association of stone formation due to gender, race, etc? Answer in at least 8-10 complete sentences for full credit.

Answer 1

flank pain is the discomfort in the upper abdomen or back and sides, it arises in the area below the ribs and above the pelvis, constant and severe flank pain may indicate serious medical condition , such as dehydration, urinary tract infection, kidney stone and any kidney problem causes persistent flank pain.

Causes of flank pain

. kidney infection, kidney abscess, kidney stones, dehydration, bladder infection, shingles, arthritis, a spinal fracture, disc brakes,pancreatitis, appendicitis, muscle spasm, pneumonia, inflammatory bowel disease, renal in fact that causes block blood supply, herpes zoster.

Finding of stone analysis may be done by

1. Burning or pain when you pass urine.

2. Constant urge to pass urine even when you have just went.

3. Cloudy or bad smelling urine.

4. lab test E. Coli reveals presence of e coli that causes infection to bladder.

Other microbes that gets entered into the skin and makes the way to to enter into the blood then travel to the kidney that causes infection.

Condition that causes decrease parathyroid hormone and increase calcium level.

when calcium level in blood is very high the cells of parathyroid makes less parathyroid hormone that allows calcium level to decrease, this feedback mechanism runs constantly in normal human being.

parathyroid regulates calcium level in the blood by increasing the calcium when they are too low, it does this through its action on the kidney, blood and intestine.

Parathyroid hormone stimulate the release of calcium from calcium stores in the blood that causes destruction to the bone.

when too much of calcium is released by the bones into the blood that gets accumulated into the kidney and causes renal stone, and PTH gets shut down.

Negative feedback for PTH.

pth is mainly controlled by negative feedback of calcium level in the blood to the parathyroid glands .

low calcium levels stimulates parathyroid hormone secretion where is high calcium prevent release of parathyroid level.

Risk factors for kidney stone.

Previous history of kidney stone

If already there was a case of kidney stone in your family member.

Dehydration

Less intake of water.

Diet high in protein, sugar and sodium.

History of gastric bypass surgery.

History of polycystic kidney diseases.

conditions that cause urine to contain high level of cystine, oxalate, uric acid and calcium.

Irritable bowel syndrome.

Medicine such as diuretics, calcium based antacids.

possible treatment are:

1. Blood test for calcium Phosphorus, uric acid and electrolytes.

2. Blood urea nitrogen and creatinine test.

3. Urine analysis to check bacteria, blood, white cells.

Medications are:

1.Thiazide diuretics to prevent calcium stone from forming.

2. Sodium bicarbonate or sodium citrate to make the urine less acidic.

3. Phosphorus solution to prevent calcium from forming stone.

4. Brufen or acetaminophen are given to relieve pain specially flank pain.

5. Ursodeoxycholic acid is given to dilute the stone and make it excreted through the urine.

Surgical treatment:

1.lithotripsy is performed to break down the stone and removed it by making a hole on the abdomen with the use of waves.

2. Percutaneous nephrolithotomy is also performed to remove the kidney stone.

stone formation due to gender and race are white people are more prone to get kidney stone then black people and also men develop more kidney stone than women.