renal stone case presentation

2. 40 Years old Male
Presented with Left
loin Pain
Presented by
Dr. Md. Tasnimul Khair Shovon
MS- Student (Part- 3)
Department of Urology
Sir Salimullah Medical College and Mitford hospital

3. Patient Profile
 Name : Md. kamal
 Age : 40 years old
 Sex : Male
 Religion : Islam
 Occupation : farioala
 Marital Status : Married
 Address : Munshigonj
 Date Of Admission : 22.08.2022
 Date Of Exam : 25.08.2022

4. Salient feature
Mr. kamal, 40 yrs old, male, muslim, married,
ferioala from munshigonj presented to me with
the complaints left loin pain for 3 years which
is dull aching in nature but sometimes sharp in
nature, mild to moderate in severity, it was
started in suddenly and present almost all time
but has no radiation.

5. Pain is aggravated by jolting movement
and walking but relieved by taking rest and
some medication which was prescribed by
local doctor. It has no relation with food.
Patient has a history of passage of one stone
through urine 6 months back.

6. There is no history of fever with chill and
rigor. There is no history of hematuria or
passage of fleshy material through urine.
Patient has no history of increased
frequency of micturition, urgency, dysuria
or evening rise of temperature.

7. He has no history of per-urethral
catheterization or instrumentation. There is
no history of anorexia, weight loss, cough,
chest pain, haemoptysis, hematomesis,
jaundice, melena or bone pain. There is no
history of blood transfusion. Patient bowel
habit is normal.

8. Patient is smoker and diabetic for 3 years
and maintains lower socioeconomic
condition.
On general examination all parameter are
within normal limit.

9. On genitourinary system examination
Kidney and urinary bladder are not
palpable, left renal angels are tender, hernia
orifice are intact.

10. EUM, penis, palpable part of urethra,
scrotum, testes, epididymis and perineum
are normal. On digital rectal examination
nothing abnormality detected. Other system
revels no abnormality.

11. Provisional Diagnosis
 Left renal stone

12. Differential diagnosis
 Left ureteric stone

13. Investigation
 Plain x-ray KUB-
bilateral renal stone

14.  S. creatinine – 1.22
mg/dL

15. Intravenous urography (IVU)

18. Ultrasonography of KUB
 Bilateral renal stone
 Right upper ureteric
stone
 Right sided
hydronephrosis

19. Complete blood count
 HB- 15.1 gm/dL
 TC- 9200/ cumm
 ESR- 32 mm in 1st hr

20. Urine routine and microscopic
examination
 RBC = plenty/HPF
 Pus cell – 25-35
/HPF

21. Urine culture and sensivity
 No growth

22.  S. parathyroid
hormone - 14.30
pg/ml

23.  s. calcium- 10.5
mg/dL
 S. uric acid- 6.8
mg/dL

24.  24 hr urinary sample
 urine calcium level (normal < 300
mg/24hr)
Urine uric acid ( <800 mg/24hr)
Urine oxalate ( <50 mg/24hr)
Urine citrate ( 450-600 mg/24hr)

25.  Blood group – ‘o’ positive
 ECG- normal
 Chest x-ray – normal
 RBS- 13.78 mmol/L

26. Confirmatory diagnosis
 Bilateral renal stone with right upper
ureteric stone

27. Treatment
 Right sided push back percutaneous
nephrolithotomy (PCNL).
 Later date left sided PCNL.