Stuart is a 65 year old retired lawyer. For weeks now he has been having a low g
ID: 3524742 • Letter: S
Question
Stuart is a 65 year old retired lawyer. For weeks now he has been having a low grade fever which seems to be going up, severe pain in his lower abdominal region especially lower back, and nausea. He went to his physician who ordered a variety of clinical tests in an effort to figure out the cause of the reported clinical manifestations. Stuart does not have abdominal obstruction nor an infection. But the XRAY showed a whitish spot on his right ureter.
Based on the clinical manifestations and test results,
1. 1.What is Stuart ‘s DIAGNOSIS? (A)
2. 2 What would be the suggested TREATMENT? ( B)
3. 3 How may this be related to his DIET? (C)
4. 4 Could this be due to an overactive endocrine gland ? explain (D)
5. 5 What is the PROGNOSIS? (E)
Explanation / Answer
1. Stuart's diagnosis indicates Nephrolithiasis(commonly known as kidney stones) because kidney stones are the crystalline aggregates of dissolved minerals in the internal linings of kidneys,especially Calcium oxalate which could be identified by white spot in the KUB(Kidney, Ureter, Bladder) X-ray. Also, when these stones start passing the ureters, it leads to severe pain in the lower abdominal region along with nausea and fever which are exactly the symptoms faced by Stuart. Therefore, the diagnosis is Nephrolithiasis.
2. In order to look for the suggested treatment, it is important to know the major cause of these kidney stones so that it could be countered.They are generally formed as large aggregates when the person is not sufficiently hydrated which does not dilute the uric acid, an important component of urine making the urine highly acidic leading to the formation of kidney stones.Therefore, rehydration via Intravenous(IV) tube along with anti-inflammatory medications may be administered.
In some cases, Urologists can go for "Lithotripsy", a kind of shock wave treatment to break down the kidney stones into smaller pieces to relieve their passage through ureters.
If the stone size is too large, then surgical removal of the stone via an incision in the back or via the thin tube insertion in the urethra, serves the ultimate option.
Besides, physicians may also prescribe some medications to relieve other medical symptoms like anti-emetics to relieve nausea and vomiting, anti-pyretics to reduce fever.
3.The stones buildup is mostly related to his diet because, the medical symptoms only arises when the stone buildup has reached larger sizes, else smaller ones pass unnoticed. The stones buildup is probably because Stuart's diet intake is high in Calcium and Vitamin D supplements which usually 65 years old people take. Also, high proteinaceous and sodium rich diet also leads to this condition. I t is also believed that common salad fruits like tomato very high intake on regular basis may also contribute to the stone build up.
Also,some common medicines prescribed for old age related problems like intake of topiramate which is used to treat seizures nd migraine headaches often leads to increase the likelihood of kidney stones development.
And, the major part is that Stuart's water intake would have been very lesser than the recommended eight to ten glasses of water everyday.
4. Yes, One of the major cause of the Kidney stones formation is the tumor in one or two glands out of four parathyroid glands, which results in hyperparathyroidism. Parathyroid gland produces parathyroid hormone(PTH) which results in controlling calcium levels in blood and bones.When these tumorous glands produce excessive PTH , the calcium from the bones is released excessively in the blood which eventually gets deposited in the kidney inner linings when blood is filtered via kidneys thus producing kidney stones.
5.The prognosis is that the recurrence of kidney stones is 50% in 5 years in first time stone formers and 80% in 10 years and Stuart at this age could be more prone to recurrence because his current age invites many age related metabolic disorders if he does not follow healthy lifestyle.