CASE ANALYSIS

GROUP 7 MT3D
 CASE
An obese patient is presented with the following symptoms:
Severe pain in the side and back,
Pain during urination,
Persistent need to urinate but in small amounts of urine.
He also told the doctor that his urine seems reddish.
Imaging test reveal that the patient has kidney stones. The
patient went through surgery to remove the kidney stones. The
stones were then sent to the laboratory for analysis. The stone
appears to be dark in color and very hard with rough surface.
Upon chemical examination, test results show that the stone is
made up of calcium oxalate.
PERTINENT INFORMATION
Patient as stated is obese.
Approximately 50% of the oxalate typically present in
urine is derived from ascorbic acid (vitamin C), an oxalate
precursor or from oxalic acid. Food high in oxalic acid or
ascorbic acid include vegetables (rhubarb, tomatoes,
asparagus, spinach) and citrus fruits. In addition,
beverages that are high in oxalic acid include cocoa, tea,
coffee, and chocolate.
As urine forms in the renal tubules, oxalate ions associate
with calcium ions to become calcium oxalate. When
conditions are optimal, calcium oxalate can precipitate in
a crystalline form.
 Calcium calculi are frequently associated with metabolic
calcium and phosphate disorders and occasionally diet.
Small calculi may be passed in the urine, subjecting the
patient to severe pain radiating from the lower back to
the legs.
GUIDE QUESTIONS

1. What chemical examination is done

to identify the composition of the
kidney stone in this case?
The solubility test is performed to aid in the
identifying the composition of the kidney stone.
Wherein calcium oxalate will yield these results;
Soluble - Hydrochloric Acid
Insoluble Acetic Acid
2. What are the different tests
included in kidney stone analysis?
Describe each briefly.
Physical and Chemical methods are both used for analysis.
Unfortunately, chemical methods often are inadequate to analyze
accurately urinary calculi and could fail to detect some elements into the
stone. Physical methods, in counterpart, are becoming more and more
used in high-volume laboratories.

Physical Test Identifies the morphology of the stone and provides a

semi-quantitative evaluation of their proportions within the stone.
X-ray Diffraction Method
Fourier Transform Infrared Microscopy
X-ray Crystallogy
Chemical Test Identifies the chemical composition of the kidney
stone.
pH dependency
Solubility Tests
3. Enumerate and describe the
different possible compositions of
kidney stones.
PATHOPHYSIOLOGY
Kidney stone formation may result when the urine becomes
overly concentrated with certain substances. These substances
in the urine may complex to form small crystals and
subsequently stones.
Stones may not produce symptoms until they begin to move
down the ureter, causing pain . The pain is severe and often
starts in the flank region and moves down to the groin.
The size of the renal stone will dictate the natural history of
this condition. If the stone is less the 5mm in diameter, then it
will most likely pass on future urination. If the stone is larger
than 5mm, urological procedures may be required to remove
the stone. Surgical intervention will be required in any patient
whose urinary tract in completely obstructed. This situations
REFERENCES:
Urinalysis and Body Fluids by Strasinger, Susan King, Di
Lorenzo, Marjorie Scaub, page 157
Henrys Clinical Diagnosis and Management by Laboratory
Methods page 475
Graffs Textbook of Routine Urinalysis and Body Fluids page
page 63
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308647/
https://labtestsonline.org/understanding/analytes/kidney-stone-
analysis/tab/test/