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Clinical Crossroads | Clinician's Corner

A 44-Year-Old Woman With Kidney Stones

Gary C. Curhan, MD, ScD, Discussant
JAMA. 2005;293(9):1107-1114. doi:10.1001/jama.293.9.1107.
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DR BURNS: Ms P is a 44-year-old woman with a history of morbid obesity and superficial thrombophlebitis who was diagnosed with kidney stones 1 month ago. She recently lost her medical insurance and is applying for free care. She is currently unemployed and lives with her daughter.

While on vacation in Jamaica, Ms P developed severe diarrhea without nausea, vomiting, or fever. After returning to the United States her diarrhea resolved, but she developed brown urine that lasted for several days. She subsequently developed bilateral intermittent low back pain that she treated with acetaminophen and ibuprofen with good relief. She denied any radiation of the pain or any associated weakness or numbness. She had no fever, dysuria, or urinary frequency. She never had similar symptoms in the past. She does not smoke and denies alcohol use.

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Figure. Helical Computed Tomographic Scan of the Upper Abdomen
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High-resolution helical computed tomographic image demonstrating a stone in the right renal pelvis and a smaller stone in the left kidney (arrowheads). There is no hydronephrosis.

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