Mark, aged 36 years, is a sales executive who presents with a 5-hour history of right loin pain of moderate intensity associated with nausea and urinary frequency: renal medicine Assignment, USW, Malaysia

Mark Has Bad Pain In His Loin
Mark, aged 36 years, is a sales executive who presents with a 5-hour history of right loin pain of moderate intensity associated with nausea and urinary frequency.  Mark has been well in the past or has no family history of renal stones. He takes no regular medications.
Examination:

• Afebrile, pulse rate 88/min
• BP 135/80 mmHg
• Mild right iliac fossa tenderness
• No evidence of peritonitis
• Urinalysis- microscopic haematuria

Question 1
How would you manage Mark?

Question 2
What is the most appropriate investigation to confirm the presence of a stone in the cases of suspected ureteric colic?

Further information
You advise Mark to present to the ER if the pain persists and filter his urine in order to obtain a stone for analysis. His pain persists so he presents to the ER.

Question 3
When do patients with ureteric colic require surgical intervention?

Further information
Mark wants to know why he has made urinary stones and whether he could have done something wrong that made his body form the stones

Question 4
What would you say to Mark about the reason for his urinary stones?

Question 5
What investigations are warranted in Mark to exclude a cause of stone formation?

Question 6
Does Mark’s asymptomatic left renal stone require intervention?

Answer

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