A 42-year-old man comes to the hospital for sharp right-sided flank pain that radiates started two hours ago. The pain is also colicky and radiates to the right groin. The patient has no nausea or vomiting. He has a history of crohn disease for which he takes his medications regularly. Urinalysis shows hematuria. A day later, the patient passes a urinary stone. Abdominal imaging reveals several additional kidney stones. Which of the following is the most likely underlying cause of this patient's kidney stones?

Question

A 42-year-old man comes to the hospital for sharp right-sided flank pain that radiates started two hours ago. The pain is also colicky and radiates to the right groin. The patient has no nausea or vomiting. He has a history of crohn disease for which he takes his medications regularly. Urinalysis shows hematuria.  A day later, the patient passes a urinary stone.  Abdominal imaging reveals several additional kidney stones.  Which of the following is the most likely underlying cause of this patient's kidney stones?

Quizplus · Accepted Answer

Eductional Objective: Crohn disease is associated with oxalate kidney stones.  Impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption.  Intestinal lipids then bind calcium ions, and the resulting soap complex is excreted.  Free oxalate (normally bound by calcium to form an unabsorbable complex) is absorbed and forms urinary calculi (enteric oxaluria).

A 42-Year-Old Man Comes to the Hospital for Sharp Right-Sided