Scenario 2 - Part 3:

The patient was started Vitamin B6, potassium citrate and lithotriptics. He was advised to have a moderate calcium diet and avoid oxalate, VIT-C and fatty food. Three months later, the patient had gradual improvement with normalization of his laboratory abnormalities.

  1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.

26 Comments

  • Marwa Alm


    – 24hrs urinary profile (Na, K, Ca, Pi, uric a, oxalate, Cr, volume, PH),
    – complete serum metabolic panel, VBG
    – PTH, vitamin D, ALP,
    – Stone analysis

  • Khaldon Rashed Ahmed Moqbil


    • 24 h urine Ca ,oxalate ,citrate
    • Renal function test
    • SCa ,S.po4 ,PTH, serum mg
    • USKUB 
    • CT KUB
  • Asma Aljaberi


    1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
    • 24 hrs urine Cr, Ca, Na, uric acid, oxalate and citrate.
    • Renal stone analysis
    • PTH, Ca corr, PH levels.
    • Serum urea and lytes
  • Areij Alotaibi


    Renal profile
    24 urine electrolyte
    stone analysis

  • Muhammad Soobadar


    24 hr urine two collection
    urine volume /ph citratre/oxalate/calcium/na/k /creatinine
    Serum Calcium/Phosphate/PTH/Vitamin D

  • Mohamed Abdulahi Hassan


    metabolic evaluation of un complicated calcium stones formers
    cbc, calcium , uric acid , pth ,rnal function , citrate

  • Rania Mahmoud


    1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
    • CBC
    • Urine analysis , including at least two 24-hour urine collections.
    • 24-hour urine collection, the urine volume, pH, and excretion of calcium, uric acid, citrate, oxalate, sodium, potassium and creatinine .
    • Serum calcium, uric acid, urea , creatinine and PTH should be measured to detect any metabolic abnormality
  • Rabab Elrefaey


    Good job dear doctors.

    1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.
    Analysis of the stone is an essential part of the evaluation of patients with established nephrolithiasis. The complete metabolic evaluation for nephrolithiasis consists of both blood and urine testing, including at least two 24-hour urine collections. In each 24-hour urine collection, the urine volume, pH, and excretion of calcium, uric acid, citrate, oxalate, sodium, potassium and creatinine (to assess the completeness of the collection) should be measured. Serum calcium, uric acid, creatinine and PTH should be measured to detect any metabolic abnormality

  • Mahmoud Elsheikh


    •  24 h urine Ca ,oxalate ,citrate
    • Renal function test
    • SCa ,S.po4 ,PTH, serum mg
    • USKUB
    • CT KUB
  • Asmaa Salih KHUDHUR


    Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
    Detailed dietary and drug history 
    Family history of stone forming 
    Any history of ESKD and hemodialysis 
    Any history of death due to renal failure 
    Complete metabolic screen 
    Stone analysis 
    24hr urinary measurements of ca , oxalate,p, citrate,cystine , creatinine.
    Genetic study to exclude hyperoxaluria and cystinuria.

  • Rabab ALaa Eldin keshk Rabab


    Suggestions were 24 h urine ca ,oxalate ,citrate evaluation,renal function test,serum uric acid
    -SCa ,S.po4 ,PTH, serum mg
    us KUB /CT KUB

  • Riaan Flooks


    Approach

    • Do a 24-hour urine collection for urinary calcium, uric acid, citrate, oxalate and phosphate
    • Do a thorough medical interrogation, specifically looking for Hyperuricaemia, renal tubular acidosis, Parathyroid disease and Repeated urinary tract infections
    • Do a urinary microscopy, culture and sensitivity
  • Ahmed Altalawy


    Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.

    • Medical evaluation should identify patients with high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary-tract infections, cystinuria, and hyperuricosuric hypercalciuria, must be identified.
    • urine analysis.
    • follow s. calcium, phosphorus, PTH, and vit D.
    • 24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
  • Abdulrahman Almutawakel


    PATIENT NEEDS DIET CONTROL , NEEDS FOR 24 HRS URINE CALCIUM , URIC ACID , OXALATE REGULLARLY , INCREASE FLUIED INTAKE AND REGULLAR FOLLOW UP

  • HASSAN ALYAMMAHI


    • Diet History
    • Drug History
    • PTH
    • Urinary Ca, Oxalate, Citrate
    • TFT
    • urine Osmolality
    • Panel 1 (looking for acid / base)
  • Hagar Ali


    -24 h urine ca ,oxalate ,citrate
    -S Cr, B urea ,SUA
    -SCa ,S.po4 ,S.mg
    -Vd, PTH
    us KUB /CT KUB

  • Israa Hammoodi


    S. Electrolyte
    25 OH vitamin D, alkaline phosphotase, s. Mg, PTH, BGA , chest x-ray
    US of renal system
    24 hrs Urine Ca, phosphorous, citrate, oxalate, Mg, creatinine

  • KAMAL ELGORASHI


    Metabolic plan

    • Assess the patient’s diabetic profile.
    • Assess Thyroid profile.
    • Workup to establish the diagnosis (RTA, FHH).
    • Serial assessment of 24 hours urinary calcium, Pi, citrate, and uric acid.
    • Serial measurement of 25(OH)vitD and PTH.

  • Nour Al Natout


    Medical evaluation include Urine analysis, monitoring of 24h Urin level of calcium , oxalate, citrate, urate , phosphate, PH and urin volume and measurment of iPTH, calcium , phosphate and uric acid and vitamin D in Serum.

  • Mahmud ISLAM


    In stone former, we need to encourage enough fluid intake low in sodium. Uric acid stones are managed with hydration and uricosuric drugs like allopurinol. Patients with hyperoxaluria are encouraged to consume low salt enough after avoidance of supplements like vitamin C and some nutrients. We need to ask for level of Ca/P7PTH, uric acid, oxalate, and citrate and 24 hours for calcium ric acid, oxalate and citrate. Patients who have obstructive stones should be consulted with urologists.

  • Weam El Nazer


    1. Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.

    medication and diet history
    total serum calcium and ionized
    urine analysis and PH
    24-hour urinary calcium, oxalate, uric acid, and citrate 
    iPTH, 25(OH) Vit-D
    Calcium /creatinine
    Serum PH, HCO3

  • Ben Lomatayo


    1. Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.

    • Rule out RTA e.g Metric utine PH, blood PH, serum HCO3, serum K
    • Abdominal X ray or CT KUB
    • iPTH
    • 24 H urine for : PH, Volume, Na, K, Ca, PO4, Mg, Citrate, Oxalate, Uric acidt
    • Dietary history of high salt intake, or consumption of high doses of vitamin D
  • Rihab Elidrisi


    1. Suggest an approach to the metabolic evaluation of uncomplicated calcium stone formers.
    • Medical evaluation should identify patients with a high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary tract infections, cystinuria, and hyperuricosuria hypercalciuria, must be identified.
    • Urine analysis.
    • Follow s. calcium, phosphorus, PTH, and vit D.
    • 24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
  • Ashraf Ahmed Mahmoud


    Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.

    • Medical evaluation should identify patients with high risk for recurrent stone disease. Underlying medical disorders, such as gout, renal tubular acidosis, hyperoxaluria, hyperparathyroidism, urinary-tract infections, cystinuria, and hyperuricosuric hypercalciuria, must be identified.
    • urine analysis.
    • follow s. calcium, phosphorus, PTH, and vit D.
    • 24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
  • Ibrahim Omar


    Suggest an approach to metabolic evaluation of uncomplicated calcium stone formers.

    • check serum calcium, phosphorus, PTH, ALP, and 25-hydroxy vitamin D.
    • 24-hour urinary calcium, oxalate, phosphate, urate, and citrate.
    • possible imaging as chest X-ray, HRCT chest, parathyroid CT, possible sestamibi scan.
    • specific treatment of the possible cause.

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