Nephrolithiasis

Respond to at least two of your colleagues on two different days who selected different disorders and factors than you, in the following ways: Share insights on how the factor you selected impacts the pathophysiology of the disorder your colleague selected. Expand on your colleague’s posting by providing additional insights or contrasting perspectives based on readings and evidence. Peer post Nephrolithiasis Case Scenario A 41-year-old obese female comes to the office complaining of nausea, vomiting, and sharp flank pain. Upon inspection, she is sensitive to pressure to the flank areas. She reports some pain recently when urinating and urine is amber or dark colored. She states she has had Obera balloon implant in the abdomen for weight loss. The intended effect is to limit large amounts of food intake by making a patient feel “full.” For the last four months, she reports not drinking sufficient water because her stomach feels full or feel nauseated after. She reports she may drink less than one liter of water a day and frequently when she does, she vomits about an hour later. Also, she reports being constipated more since Obera implant placement. Many studies are suggesting a link between obesity and stone formation." Patients who have undergone bariatric surgery show a twofold increased risk of kidney stone formation compared with similarly obese patients who have not undergone bariatric surgery "(Tarplin, S., Ganesan, V., & Monga, M., 2015). According to Dr. Buttaro, a practitioner must ask five questions when assessing a patient: what the patient would complain about: what you would look for in the physical exam; what tests might be done; what kind of treatment will be needed; and what you will need to teach the patient (Laureate Education, 2012d) A practitioner would quickly consider a patient’s verbal history of nausea, flank pain, dehydration and combined with a non-contrast Ct scan. Radiologic evaluation should also be performed in all patients at the time of their initial stone event (Ennis J., & Asplin J., 2016). A simple 24-hour urine collection usually reveals a higher than normal calcium content. According to Hammer & McPhee (2014), a variety of disorders may result in the development of renal stones, at least 75% of renal stones contain calcium. A 24-h urine collection can detect the presence of systemic disease and identify treatable dietary and lifestyle factors linked to kidney stone formation (Ennis J., & Asplin J., 2016). Dehydration and reduced urinary volume are well-known risk factors for kidney calculus formation (Hadian, B., Zafar-Mohtashami, A., & Ghorbani, F., 2018). A contributing factor, in this case, would be the low intake of fluids. There are significantly higher levels of total serum cholesterol and triglycerides in people who developed a kidney stone. For total cholesterol, this relationship was accentuated in patients with uric acid and calcium oxalate monohydrate-dihydrate stones (COM-COD). Multiple studies recommend that for prevention of nephrolithiasis, urine volume must be more than 2 L/d (Hadian, 2018). Insulin resistance is also associated with decreased ammonium production in the proximal tubule resulting in decreased urine pH, the major driver of uric acid stone formation (Boyd, Wood, Whitaker, & Assimos, 2018). The factors that contribute or may be affected by kidney stones include obesity, hypertension, insulin resistance/diabetes, and hyperlipidemia/dyslipidemia.            

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