May 2003: Case Study 1

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NR, a 36-year-old man, presents to his physician complaining of acute abdominal pain. He is convinced that he has kidney stones once again. He describes the pain as excruciating, intermittent, right-sided, and radiating to his groin. The patient is diaphoretic and has difficulty sitting still.

The physician notes that NR?s previous stones were identified as calcium oxalate. The doctor orders an x-ray and ultrasound, which confirm that NR has kidney stones again. Because the stones are small, the physician prescribes oxy-codone with acetaminophen until the stones pass.

NR does not understand why he developed stones again. After his last episode, he promised himself that he would stay healthy. He has a very extensive exercise regimen and ingests excessive amounts of vitamins, particularly vitamin C.

Why would NR?s exercise program and vitamin intake make him a candidate for further stone formation?

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Calcium stones are often seen in patients with sedentary lifestyles or low urinary output. Increased urine concentration, caused by inadequate fluid replacement after exercise, plays a part in the formation of calcium stones. High oxalate concentrations, from excessive doses of vitamin C, lead to the formation of calcium oxalate stones.