A CLINICO-SOCIAL CASE STUDY ON-

RENAL CALCULUS

BY :- KHAGESH LAWANIYA
ROLL NO 47
BATCH 2022
 FAMILY STUDY
Aim:-

❖ To study the effects of various socio-demographic factors on the health of a family.

❖ To suggest preventive measure about the common health problems.

❖ To eliminate or reduce health problem or its consequences if any.

Objectives:-

❖ To study the medico-social problems of the family.

❖ To study the risk factors responsible for the health problems.
❖ To find out their dietary pattern and its co-relation with health disorders.
❖ To study environmental and its impact on the family.
❖ To impart health education to the family.
Information was obtained in the following way:
1. Direct observation .
2. Asking question to the family members .

In this visit I was allotted the family of Mr Eeshri for a detailed case study of
Renal calculi.

MATERIALS -
● predesigned questions
● Measuring tape
● Hemoglobinometer
● Digital bp machine
● Stethoscope
● Apron
 FAMILY STUDY
BATCH NO: C
Name & roll no. of students:
KHAGESH LAWANIYA 47

GENERAL INFORMATION:

A. Residential Status:
1. Living in SAHDOLI Village Alwar since 3 generations

B.Environmental Sanitation: Area near the house was clean .There was collection of some water
in dumps in front & near the house which could act as potential breeding places for mosquitoes.
C.Housing:
Type of floor: RCC, Type of wall: Brick ,Type of roof: RCC
Height of roof: (10 ft).
Total members living in the household: 6, Total floor area (sq. ft.): Approx 600 Square feet
Total rooms: 3
Living Rooms: 3
Overcrowding: No

Kitchen: The gas used was present on a counter of about 2 feet

Fuel used: LPG Cylinder,
Cross-ventilation: Present
Natural lighting inside the house during day time: adequate

D. Disposal:
No community dustbin ,disposal of waste in open area

E. Toilet:
Own with open sewage system.

F. Water Supply:
borewell water supply. Frequency of water supply: once a day
 FAMILY PROFILE
Relation Specific
Age/
Name with Occupation Education Income health
gender
head problem

EESHRI Self 60/m Labour primary 5000 -

AIMANA wife 55/f Housewife primary - Renal calculi

RASHID KHAN son 31/m Factory worker diploma 10000 -

Daughter in
RAHILA 25/f housewife Primary -- -
law

AYAN Grand son

2.5/m - - - -

AARYAN Grand son 7mo/m - - - -

 Socioeconomic Per Capita
class
Income
(Grade)
Social Classification:
1. Religion- muslim upper (I) >9414
2. Caste- OBC
3. Family type- joint Upper middle (II) 4707-9413
4. Family size- 6 members
5. Total family monthly income- Rs. 15000 Middle (III) 2824-4706
6. Per capita monthly income- Rs. 2500
7. Social class(as per modified Prasad)- class IV Lower Middle (IV) 1412-2823
From updated BG PRASAD Scale 2025
lower (V) <1412
1.There is no history of birth in last one year.
2. There was no history of death in last one year .
3. There was no history of marriage in last one year .
4.There was no history of divorce in last one year.
5. There was no migration in last one year.
6. There was no history of hereditary disease and congenital
malformation.
 Sessions Items Amount (g/ml) Calories (kcal) Proteins (g) Fats (g)

Morning Tea Tea with sugar 200 ml 60 1.5 3

DIETARY Lunch
Biscuits

Chapati
40 g (≈4 pcs)

24 pcs (~960 g flour)

200

2,880
3.0

72.0
8

24.0

SURVEY Dal (thick) 200 g 320 16.0 8.0

Vegetable curry 400 g 200 6.4 9.6

∙ Total no. of CU required= 5.2 Salad 100 g 30 1.0 0

∙ Total intake of calories/day =

Oil used in cooking 85 g 765 0 85.0
9230 Kcal
∙ Total intake of Evening Tea Tea with sugar 200 ml 60 1.5 3

protein/day=203.8 gm ( req Biscuits 40 g (≈4 pcs) 200 3.0 8

254 gm) Dinner Chapati 24 pcs (~960 g flour) 2,880 72.0 24.0

∙ Required calories/day Dal (thick) 150 g 240 12.0 6.0

5.2*2400 = 12480 Kcal
Vegetable curry 400 g 200 6.4 9.6
∙ There is energy deficit in 26 %
calories and 20% in proteins Oil used in cooking 85 g 765 0 85.0

∙ there are some assumptions

were taken while making the Any Other Food Milk (toddler) 250 ml 150 5.0 7.0

survey actual results may vary Breastfeeding 400 ml 280 4.0 3.0

TOTAL (Family) 9,230 203.8 283.2

 Case study
presenting a case of 55 yr old muslim lady residing in sahdoli village alwar
Presenting illness she is a known case of renal calculus operated in dec
2024

HOPI- The patient was apparently well until around June 2024, when she first
developed dull aching pain in the left loin.
• The pain was gradual in onset, intermittent in nature, and non-radiating initially.
• It was localized to the left lumbar region, with occasional exacerbations, especially
after increased fluid intake and exertion.
• Pain was not relieved by change in posture or meals.
About two months later (August 2024), the pain became colicky in character,
radiating from the left loin to the groin and inner thigh, suggestive of ureteric colic.
• Pain was severe enough to make her restless and required injectable analgesics on
two occasions.
• There was associated nausea and occasional vomiting during acute episodes.
She also noticed:
Increased frequency of micturition and burning sensation during urination.
Episodes of hematuria (reddish discoloration of urine, painless, occurring towards the
end of micturition).
No history of passage of stones per urethra.
In October 2024, she developed fever with chills and rigors, suggestive of urinary
tract infection. She was hospitalized, given antibiotics and IV fluids, and subsequently
investigated.
Ultrasound KUB revealed a 2.8 cm calculus in the left renal pelvis with mild
hydronephrosis.
Later, NCCT KUB confirmed a renal pelvic calculus with lower calyceal extension.
She underwent surgical management(PCNL) in December 2024 in SMS Hospital
jaipur .Post-operative period was uneventful, and she was discharged with advice for
high fluid intake, dietary modifications, and follow-up.
PAST MEDICAL HISTORY

Was on post op medicines like NSAIDS(aceclofanac ) ,Broad spectrum

antibiotics(cefixime),urine alkalinisers(potassium citrate ),antispasmodic(drotaverine),PPIs

PAST SURGICAL HISTORY

Known case of operated renal calculus

PERSONAL HISTORY

Sleep was disturbed due to pain, No loss of appetite,no loss of weight. Normal bowel and
increased frequency of micturition ,Non smoker, non alcoholic, No known drug or food
allergy. Now she is doing well

FAMILY HISTORY

Her father was also a known case of renal calculus

 GENERAL PHYSICAL EXAMINATION
● Patient is lying comfortably in semi-recumbent position, alert and cooperative. she is moderately built
and well nourished.
● Height 161 cm weight 55 kg BMI 21.23

● Vital signs were stable:

○ PR: 70 bpm, regular rhythm, normal volume and character

○ BP: 130/82 mmHg
○ RR: 18 breaths/min
○ Temperature: Afebrile to touch

● There is
○ No pallor
○ No pedal edema
○ No icterus
○ No lymphadenopathy
○ No clubbing and no cyanosis
● Cardiovascular system, Abdominal examination and Respiratory examination : no abnormality found
ADVICE GIVEN TO THE PATIENT
1. General Lifestyle Advice

• Adequate hydration: Drink at least 2.5–3 liters of water per day (maintain urine output >2 L/day).
• Spread water intake throughout the day; also drink before bed to avoid concentrated urine overnight.
• Avoid dehydration (especially in summer, during work, or with fever/diarrhea).

2. Dietary Advice

• Reduce oxalate-rich foods: Spinach, tomato, brinjal, nuts, tea, cocoa, beetroot.
• Limit salt intake: Excess sodium increases calcium excretion → stone risk.
• Limit animal protein: Red meat, fish, chicken in large amounts increase uric acid & calcium stones.
• Maintain normal calcium intake: Do not excessively restrict milk/curd, because very low calcium increases
oxalate absorption.
• Increase citrus fruits (lemon, orange, mosambi): Natural citrate prevents stone formation.
• Prefer a balanced diet with adequate vegetables, fruits, whole grains.
CONTD…
3. Medical Compliance
• Continue potassium citrate or other prescribed medications as advised.
• Take antibiotics only if prescribed for UTI.
• Avoid unnecessary painkillers (NSAIDs) unless directed.
4. Follow-up and Monitoring
• Regular follow-up at urology/medicine OPD (every 6 months initially).
• Ultrasound KUB once a year (or earlier if symptoms recur).
• Urine routine and culture if burning micturition/fever occurs.
• Periodic renal function tests (urea, creatinine, electrolytes).
UNDERSTANDING RENAL CALCULUS
 INTRODUCTION

•Renal calculus (kidney stone) is a solid crystalline mass formed within

the renal pelvis, calyces, or urinary tract due to precipitation of urinary
solutes.
•It is one of the commonest urological problems worldwide and a major
cause of recurrent flank pain and hematuria.
•Stones can vary in size (microliths to large staghorn calculi) and
composition (calcium, uric acid, cystine, struvite).
•They may remain silent, cause renal colic, or result in obstruction,
infection, or renal damage.
ETIOLOGY/ RISK FACTORS
•Metabolic causes
1.Hypercalciuria (idiopathic, hyperparathyroidism, sarcoidosis)
2.Hyperoxaluria (primary, secondary after bowel resection, IBD)
3.Hyperuricosuria (gout, myeloproliferative disorders)
4.Cystinuria (rare inborn error of metabolism)
•Anatomical causes
•Pelvi-ureteric junction obstruction
•Horseshoe kidney, medullary sponge kidney
•Vesicoureteric reflux
CONTD….
•Infective causes
•Urease-producing organisms (Proteus, Klebsiella, Pseudomonas) → struvite
stones
•Environmental / Dietary factors
•Low fluid intake (dehydration, hot climate)
•High intake of oxalate (spinach, tea), animal protein, salt
•Excess vitamin D or calcium supplements
•Vit A deficiency causes desquamation of epithelium which act as a nidus for stone
formation
•Other risk factors
•Sedentary lifestyle, immobilization
•Family history (genetic predisposition)
CLINICAL FEATURES
•Renal colic: Severe, sudden, colicky flank pain radiating to groin, scrotum/labia;
often associated with restlessness.
•Hematuria: Microscopic or gross.
•Nausea, vomiting due to reflex GI irritation. pylorospasm
•Tenderness in renal angle ,with often a mass in the loin due to hydronephrosis
which moves with respiration and is bimanually palpable.
•Anuria: If bilateral obstruction or stone in solitary kidney.
•Fever, chills: Suggest superadded infection (pyonephrosis, urosepsis).
•Asymptomatic: Sometimes detected incidentally.
TYPES OF RENAL CALCULI
1. Calcium stones (70–80%)
•Calcium oxalate (most common) a/k/a mulberry stone
•Calcium phosphate
2. Struvite (15%)
•Magnesium ammonium phosphate
•Associated with chronic UTI (urease-producing bacteria)
•Form large “staghorn” calculi filling renal pelvis and calyces
3. Uric acid stones (5–10%)
•Radiolucent on X-ray, seen in gout, chemotherapy, myeloproliferative disorders
4. Cystine stones (<2%)
•Due to cystinuria (rare inherited disorder)
 SHAPES AND STAGES OF FORMATION
Type of crystal Shape of crystal
A Calcium oxalate Dumbell shaped
monohydrate
B Calcium oxalate Envelop shaped
dihydrate
C Uric acid Yellowish of varying
size and shape
D Cystine Hexagonal, very soft
stone
E Triple stone Coffin lid shaped

STAGES
1 Supersaturation 2 Nucleus formation 3 crystallisation 4 aggregation
5 matrix formation 6 stone
INVESTIGATIONS
1. Urine analysis
Microscopic hematuria
Crystals (calcium oxalate, uric acid, cystine)
Urine culture (infection stones)
2. Blood tests
Serum calcium, uric acid, phosphate, creatinine
3. Imaging
X-ray KUB: Most stones are radiopaque (calcium, struvite, cystine); uric acid
radiolucent
Ultrasound: Good for hydronephrosis, detecting stones, especially in pregnancy
Non-contrast CT KUB: Gold standard; detects all stones, size, location, density
IVU (Intravenous urography): Now rarely used; gives anatomical and functional
details
Fig1:plain x ray fig2:NCCT FIG3:USG FIG4:IVU
MANAGEMENT
A. Conservative
• Adequate hydration (2.5–3 L/day)
• Analgesics (NSAIDs) for colic
• Medical expulsive therapy: α-blockers (tamsulosin) for distal ureteric stones
• Alkalinization of urine (potassium citrate, sodium bicarbonate) for uric
acid/cystine stones
• Antibiotics if infection
CONTD….
B. Surgical / Interventional
Extracorporeal Shock Wave Lithotripsy (ESWL):
• For stones <2 cm in kidney or proximal ureter
Ureteroscopy (URS):
• For ureteric stones; stone fragmented and removed
Percutaneous Nephrolithotomy (PCNL):
• For stones >2 cm, staghorn calculi
Open surgery / Laparoscopic removal:
• Rare now, reserved for complex or large impacted stones
CONTD….
C. Preventive measures
• Increase water intake
• Dietary modifications (low oxalate, low purine, restricted salt/protein)
• Thiazides for hypercalciuria, allopurinol for uric acid stones, potassium citrate
for hypocitraturia
COMPLICATIONS
•Acute complications
•Obstructive uropathy → hydronephrosis, anuria
•Pyelonephritis, pyonephrosis
•Urosepsis
•Severe colic
•Chronic complications
•Recurrent urinary tract infection
•Chronic pyelonephritis
•Renal scarring → chronic kidney disease
•Hypertension
•Xanthogranulomatous pyelonephritis (rare, associated with staghorn stones)