Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent nephrolithiasis. Stone analysis confirms calcium phosphate (brushite/apatite) composition. History notable for [persistent alkaline urine / distal RTA / primary hyperparathyroidism / Topiramate use]. Symptoms include flank pain, hematuria, and dysuria. No history of urinary tract obstruction or infection at this time.
Clinical Examination Findings
Patient is alert and oriented, in mild distress secondary to flank pain. Vitals stable. Abdominal exam reveals tenderness at the costovertebral angle (CVA) on the [left/right] side. No palpable masses or organomegaly. Skin turgor is normal.
Treatment Protocol
Initiate metabolic workup including serum PTH, calcium, phosphorus, and 24-hour urine collection. Goal: Maintain urine pH < 6.5. Consider potassium citrate therapy if RTA is confirmed. Evaluate for Topiramate discontinuation if applicable. Increase fluid intake to ensure urine volume > 2.5L/day.