Renal calculi

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The wife of a 42-year-old man called the office stating that within the last hour her husband had a sudden onset of severe pain in his left side and back. He has also experienced nausea and vomiting. Questioning revealed the pain to be in the left flank area and quite severe. She also advised that the pain radiated down toward the pelvis and that he was experiencing pressure in the perineal area and the frequent urge to urinate. A renal calculus was suggested, and the patient’s wife was advised to transport him to an emergency facility.

Vital signs were the following: temperature, 99.6° F; pulse, 96; respiration, 20; and blood pressure, 124/88 mm Hg. A urine specimen was obtained, and the dipstick indicated blood in the urine. The abdomen was slightly distended, the left flank area exhibited tenderness on palpation, and tenderness was noted over the bladder. A renal calculus was suggested. A kidney, ureter, and bladder (KUB) radiograph, an intravenous pyelogram (IVP), and an ultrasound of the kidneys were ordered. An intravenous (IV) line was started, and the patient was given 2 mg of morphine sulfate IV push.
The KUB revealed a suspicious area, 8 cm distal to the origin of the left ureter. The IVP confirmed the presence of a 3.5 mm calculus distal to the ureteral origin. The renal ultrasound indicated hydronephrosis of the left kidney. The patient was admitted for observation and for pain management.

1. What causes renal calculi to form and why would patients’ symptoms vary?
2.What is renal colic? What would be the significant symptom or symptoms leading to the suspicion of renal calculi?
3. What is the cause of hydronephrosis?

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