Case study:
A 44 year old male patient presented to the hospital complaining of colicky abdominal pain in his both flanks, more on the right side than the left, and was associated with vomiting, the pain was so severe so he sought medical care, medical treatment was prescribed, but with no help, and renal function tests and ultrasound abdomen were requested. The patient is married and has two daughters, he is also a smoker.
The initial lab investigations showed the following:
| Lab test | Result | Reference range |
| S. creatinine | 3 mg/dl | (0.6-1.1) |
| Blood urea | 66 mg/dl | (15-45) |
Upon investigation of the kidneys, it was shown that:
◦ Bilaterally dilated pelvicalyceal system mounting to grade III-IV hydronephrosis due to renal pelvic stones measuring 3.5 cm in the right and 5 cm in the left.
◦ Bilateral middle and lower calyceal stones averaging 9- 15 mm
◦ Bilateral bright echogenicity with thinned out cortex……...?? Obstructive uropathy.
Other abdominal sonographic features are completely normal.
On finding the impaired renal functions, he was referred to Alexandria main university hospital and was admitted in the Endocrinology Unit.
On reviewing the patient history, ten years ago, the patient suffered from a similar condition when he complained of oliguria associated with vomiting, so investigations were done and renal stones were diagnosed, and a left nephrostomy operation was done.
The history provided showed that:
• No DM or hypertension.
• History of below knee amputation on due to trauma.
• Appendectomy.
• Hemorrhoidectomy.
The clinical examination of the patient was free except for left below knee amputation.
And the lab tests showed the following:
| Lab
test | Day
5 | Ref.
Range |
| S.
Creatinine | 2.1 | mg/dl
(0.7 - 1.1) |
| Blood
urea | 51 | mg/dl
(15 – 45) |
| BUN | 24 | mg/dl
(7 – 18) |
| S.
Calcium | 16.5 | mg/dl
(8.4 - 10.2) |
| S.
Phosphorus | 2.5 | mg/dl(2.5
- 4.9) |
| S.
Sodium | mmol/l(136
– 145) | |
| S.
Potassium | mmol/l(3.5
- 5.1) | |
| Total
proteins | 7.1 | gm/dl(6.4
- 8.2) |
| S.
Albumin | 3.6 | gm/dl(3.4
– 5) |
| Corrected
Ca | 16.8 | |
| ALT | 31 | u/l(30
– 65) |
| AST | 18 | u/l(15
– 37) |
| Uric
acid | 12 | u/l(15
– 37) |
Upon the information provided, What is the management of such case, what additional laboratory tests needs to be requested to reach a final diagnosis?