Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent nephrolithiasis, reporting flank pain, hematuria, and passage of gravel-like stones. History significant for familial metabolic predisposition (cystinuria). Current symptoms include [colicky pain/dysuria/frequency]. Previous stone analysis confirmed cystine composition.
Clinical Examination Findings
Abdominal examination reveals tenderness at the costovertebral angle (CVA) on the affected side. No palpable masses or organomegaly. Genitourinary exam: external genitalia normal, no urethral discharge. Systemic review: stable vitals, no signs of systemic infection or urosepsis.
Treatment Protocol
Initiate aggressive hydration (goal: >3L urine output/day). Alkalinization of urine (target pH 7.0–7.5) using potassium citrate. Consider cystine-binding thiol drugs (e.g., Tiopronin) if conservative measures fail. Surgical intervention (URS/PCNL) indicated for obstructive stones or refractory cases.