NSG 3370 WEEK 4 ASSIGNMENT 2 (DISCUSSION)
A 56-year-old female comes into the clinic complaining of intermittent severe pain that radiates
from the flank to the groin and sometimes to the inner thigh. Upon further questioning she tell
you that she has an urge to always go to the restroom and that she sometime sweats and feels
nauseous. A urinalysis provides traces of blood, a few white blood cells and no bacteria.
• What is your differential diagnosis? Discuss in detail the pathophysiology of each item in
your differential and how it might fit in describing this case.
• The x-ray comes back and there is nothing abnormal except a slightly dilated ureter. Does
this change your differential or narrow it?
• How would you treat the pain in this case?
Differential Diagnosis:
Nephrolithiasis is due to an increase in excretion of stone-forming components such as calcium,
oxalate, urate or cystine; the stones are called renal calculi (Sakhaee, Maalouf, & Sinnott, 2012).
The prevalence of kidney stones in the U.S. population is 6-12% and has become a major health
burden for those who suffer with “chronic kidney disease, nephrolithiasis-induced bone disease,
increased risk of coronary artery disease, hypertension, type 2 diabetes mellitus, and the
metabolic syndrome” (Sakhaee et al., 2012, p. 1848). Nephrolithiasis is more common in white
males between ages 20-40, though the incidence in females is higher in the late 20’s and declines
at age 50, but remains constant there after (Sakhaee et al., 2012). There are four different types
of kidney stones, each are as follows:
• Calcium – accounts for approximately up to 80% of all stones, that consist of calcium
oxalate and phosphate, and can be cause by both genetic and environmental factors
(McCance, Huether, Brashers, & Rote, 2013).
• Uric Acid – is a type of stone that is created when the urine is persistently acidic;
sometimes calcium may be found with this type stone (McCance et al., 2013).
• Struvite – results from kidney infections, primarily contains magnesium-ammonium-
phosphate and women tend to be more susceptible (McCance, Huether, Brashers, & Rote,
2013, p. 1344).
• Cystine – is rare and from a genetic disorder that leaks cysteine through the kidneys and
into the urine (McCance et al., 2013).
Renal tumor or renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignancies,
representing the seventh most common cancer in men and the ninth most common cancer in
women (Escudier et al., 2012). RCC is more common in patients with obesity, end-stage renal
failure, acquired renal cystic disease and tuberous sclerosis (Escudier et al., 2012). RCC is due to
genetics, autosomal, and hereditary. Symptoms are similar to kidney stones with complaints of
A 56-year-old female comes into the clinic complaining of intermittent severe pain that radiates
from the flank to the groin and sometimes to the inner thigh. Upon further questioning she tell
you that she has an urge to always go to the restroom and that she sometime sweats and feels
nauseous. A urinalysis provides traces of blood, a few white blood cells and no bacteria.
• What is your differential diagnosis? Discuss in detail the pathophysiology of each item in
your differential and how it might fit in describing this case.
• The x-ray comes back and there is nothing abnormal except a slightly dilated ureter. Does
this change your differential or narrow it?
• How would you treat the pain in this case?
Differential Diagnosis:
Nephrolithiasis is due to an increase in excretion of stone-forming components such as calcium,
oxalate, urate or cystine; the stones are called renal calculi (Sakhaee, Maalouf, & Sinnott, 2012).
The prevalence of kidney stones in the U.S. population is 6-12% and has become a major health
burden for those who suffer with “chronic kidney disease, nephrolithiasis-induced bone disease,
increased risk of coronary artery disease, hypertension, type 2 diabetes mellitus, and the
metabolic syndrome” (Sakhaee et al., 2012, p. 1848). Nephrolithiasis is more common in white
males between ages 20-40, though the incidence in females is higher in the late 20’s and declines
at age 50, but remains constant there after (Sakhaee et al., 2012). There are four different types
of kidney stones, each are as follows:
• Calcium – accounts for approximately up to 80% of all stones, that consist of calcium
oxalate and phosphate, and can be cause by both genetic and environmental factors
(McCance, Huether, Brashers, & Rote, 2013).
• Uric Acid – is a type of stone that is created when the urine is persistently acidic;
sometimes calcium may be found with this type stone (McCance et al., 2013).
• Struvite – results from kidney infections, primarily contains magnesium-ammonium-
phosphate and women tend to be more susceptible (McCance, Huether, Brashers, & Rote,
2013, p. 1344).
• Cystine – is rare and from a genetic disorder that leaks cysteine through the kidneys and
into the urine (McCance et al., 2013).
Renal tumor or renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignancies,
representing the seventh most common cancer in men and the ninth most common cancer in
women (Escudier et al., 2012). RCC is more common in patients with obesity, end-stage renal
failure, acquired renal cystic disease and tuberous sclerosis (Escudier et al., 2012). RCC is due to
genetics, autosomal, and hereditary. Symptoms are similar to kidney stones with complaints of
