Multiple Renal Calculi - Erler Zimmer

Multiple Renal Calculi - Erler Zimmer

Clinical History

A 68-year-old male presented with fevers and chills. Upon further inquiry, he reported a history of intermittent bilateral flank pain and hematuria over the past six months. Biochemical tests revealed significantly compromised renal function with a normal serum calcium level. A CT scan of the abdomen showed bilateral hydronephrosis, multiple renal calculi, and perinephric and subphrenic abscesses. Unfortunately, he succumbed to progressive renal failure.

Pathology

This is the patient's kidney specimen, grossly and partially bisected. The pelvi-calyceal system shows marked dilation, and renal tissue exhibits significant atrophy, reduced to a mere rim in some areas. A large mottled brown-white calculus resides in the pelvis, with a smaller calculus obstructing the ureter lumen. Proximal to the impacted calculus, the ureter is dilated. Multiple calculi are visible within the calyces.

Further Information

Urolithiasis (renal calculi) is a prevalent condition affecting up to 1 in 10 individuals. Stones can form anywhere along the urinary tract, most commonly in the kidneys. Risk factors include male gender, conditions altering urine composition (hypercalciuria or high urine oxalate), systemic metabolic disorders (cystinuria and gout), dietary factors (high oxalate and animal protein intake, low fluid intake), and environmental factors (high dry temperatures). Symptoms include severe pain, hematuria, nausea, vomiting, fainting, dysuria, and urgency. Diagnosis involves radiological tools like non-contrast CT or ultrasound. If untreated, renal calculi can lead to renal damage and failure. Treatment includes supportive care, medical therapy, and surgical intervention if necessary.