Renal Calculi Case

Module Five
Question 1
Mr Jagger is a 53-year-old male, who has presented to emergency complaining of severe left flank pain. He is in extreme distress, is very pale and is complaining that the pain is making him want to vomit. The examining physician suspects that he has renal calculi. How do renal calculi form, how are they diagnosed and what complications might arise if Mr Jagger remains untreated?

Renal calculi, also known as kidney stones, occur when glomerular filtrate passes through the nephron, where urine is concentrated with stone-forming salts (Bagga et Al., 2013). Ions in the urine are capable of forming solid salts that can grow into stones (Bagga et Al., 2013). Through the process of crystallization, a small nidus grows into a large stone when urine is supersaturated (Craft and
The walls of the renal tubules and papillae also attract crystal niduses, which facilitates their formation into stones and occlusion of the tubule (Craft and Gordon, 2010). It takes approximately 5-7 minutes for substances to pass through the collecting duct to the bladder, and during this time stone crystals bind together until they are large enough to occlude the lumen (Gnessin, E., Lingeman, J., and Evan, A., 2010).The stones are most commonly calcium based: made up of calcium oxalate, calcium phosphate or brushite (Pearle, 2012). A minority of patients will experience stones composed of uric acid, struvite or
(2013) New Insights into the pathogenesis of renal calculi. Urologic Clinics of North America, 40, (1). Pp. 1-12.
Craft, J., Gordon, C., Tiziani, A., Huether, S., McCance, K., and Brashers, V. (Eds.). 2010. Understanding Pathophysiology. Chatswood, NSW: