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Renal tubular acidosis
Minimal change disease
Focal segmental glomerulosclerosis (NORD)
Rapidly progressive glomerulonephritis
IgA nephropathy (NORD)
Acute tubular necrosis
Renal papillary necrosis
Renal cortical necrosis
Chronic kidney disease
Polycystic kidney disease
Multicystic dysplastic kidney
Medullary cystic kidney disease
Medullary sponge kidney
Renal artery stenosis
Renal cell carcinoma
Nephroblastoma (Wilms tumor)
Posterior urethral valves
Hypospadias and epispadias
Lower urinary tract infection
Transitional cell carcinoma
Non-urothelial bladder cancers
Congenital renal disorders: Pathology review
Renal tubular defects: Pathology review
Renal tubular acidosis: Pathology review
Acid-base disturbances: Pathology review
Electrolyte disturbances: Pathology review
Renal failure: Pathology review
Nephrotic syndromes: Pathology review
Nephritic syndromes: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
Kidney stones: Pathology review
Renal and urinary tract masses: Pathology review
Kidney stones: Pathology review
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Jung Hee Lee, MScBMC
Anca-Elena Stefan, MD
Sam Gillespie, BSc
In the Emergency Department, two people with similar symptoms came in.
One of them is 35 year old Conrad who has a terrible left flank pain, along with nausea and vomiting and the other one is 40 year old Sam who has left flank pain, but also has dysuria.
An electrolyte panel and urinalysis was done in both individuals.
Results showed that Conrad had normal levels of calcium in the blood, but urinalysis showed hypercalciuria and hematuria.
Sam’s urinalysis showed positive leukocyte esterase, as well as positive nitrites and hematuria. Abdominal CT showed radiopaque masses in their ureters.
Now, the suspicion is that both individuals have kidney stones, but there are actually several types of kidney stones and we need to know what we’re dealing with in order to give the right treatment.
Okay, let’s first talk about how kidney stones form.
Urine’s a combination of water, which acts as a solvent, and all sorts of particles, or solutes.
In general, when certain solutes become too concentrated in the solvent, they become supersaturated.
Urinary supersaturation of certain solutes results in precipitation out of the solution and formation of crystals.
Those crystals then act as a nidus, or place where more solutes can deposit and over time it builds up a crystalline structure.
This can happen if there’s an increase in the solute, or a decrease in the solvent, as would be the case with dehydration.
This means that dehydration leads to a low urine volume which can further put a person at risk for kidney stones.
Okay, let’s now talk about the different types of stones.
There are four main types of stones.
Calcium stones are present in about 80 percent of the cases, while struvite stones are present in about 15 percent of the cases and uric acid stones are present in about 5 percent of the cases.
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