A 57-year-old man comes to the hospital due to nausea, vomiting, and severe crampy pain in the left flank. He has had no fever or chills. Several days ago, the patient had similar, but less severe, pain that resolved spontaneously. Medical history is significant for type 2 diabetes mellitus, obesity, hyperlipidemia, hypertension, and gout. Temperature is 37 C (98.6 F), blood pressure is 160/100 mm Hg, and pulse is 98/min. Physical examination shows left flank tenderness. CT scan of the abdomen is shown below: Urinalysis for this patient would most likely show which of the following?

Question

A 57-year-old man comes to the hospital due to nausea, vomiting, and severe crampy pain in the left flank.  He has had no fever or chills.  Several days ago, the patient had similar, but less severe, pain that resolved spontaneously.  Medical history is significant for type 2 diabetes mellitus, obesity, hyperlipidemia, hypertension, and gout.  Temperature is 37 C (98.6 F), blood pressure is 160/100 mm Hg, and pulse is 98/min.  Physical examination shows left flank tenderness.  CT scan of the abdomen is shown below:  Urinalysis for this patient would most likely show which of the following?

Quizplus · Accepted Answer

Eductional Objective: Struvite stones are typically seen in patients with recurrent upper urinary infection by urease-producing organisms (eg, Proteus, Klebsiella).  Hydrolysis of urea yields ammonia, which alkalinizes the urine and facilitates precipitation of magnesium ammonium phosphate.  Urinalysis shows hematuria and elevated urine pH.

A 57-Year-Old Man Comes to the Hospital Due to Nausea