Renal Case: 49-year-old Man with Recently Diagnosed Kidney Stone

00:01 Let's turn to another clinical case.

00:03 We have a 49-year old gentleman who presents to clinic for further evaluation of a recent kidney stone diagnosed in the emergency department one week prior He has a history of hypertension and gout both diagnosed 10 years prior.

00:16 He admits that he's not been very vigilant about taking his medications on a regular basis because his work schedule has been pretty, pretty labored.

00:24 He's a construction foreman and he works about 16 hours per day.

00:28 His physical exam is remarkable for central obesity, elevated blood pressure at 148 over 90 and then erythematous tophaceous painful joints involving his metacarpal joints, his PIPs in the 2nd and 3rd digits in both of his hands.

00:44 So before we move on, what are some of the clinical clues in the history and physical exam that can help us with the cause of this patient's stone? Let's take a look.

00:54 He has a history of gout, potentially uncontrolled because remember he can't always take his medications regularly.

01:01 He's working as a busy construction foreman, puts him at risk for stone formation if he doesn't have adequate water intake.

01:08 And finally, his physical exam is very interesting.

01:11 It shows an inflammatory arthritis with involvement of both the MCPs and PIPs along with tophi.

01:18 That's really suggest of gouty arthritis.

01:21 So taken together, the history and physical exams suggest that this patient likely has uric acid stones.

01:29 So what should be done to evaluate this patient? We want to do both the basic and complete stone evaluation.

01:37 We're talk about what that means in the upcoming slides.

01:41 What are some of the important clues on physical exam that can help us with his particular stone work-up? Remember our patient had this tophaceous-looking gout, very suggestive again of having underlying uric acid stones.

01:55 And this image shows this inflammatory arthritis involving both the MCPs at the right and left upper extremities and PIP involvement as well.

02:05 Pretty profound.