Question

a 40 - year - old male patient presents to your office with back pain, nausea, and chills. his urinalysis reveals an amber color with the inclusion of red blood cells and an increased specific gravity. what is the most likely diagnosis? a) pancreatitis b) gallstones c) nephrotic syndrome d) acute glomerulonephrits e) renal calculi

Explanation:

• Pancreatitis: Main symptoms are abdominal pain, nausea, vomiting, not typically associated with hematuria (red blood cells in urine) and increased urine specific gravity.
• Gallstones: Usually cause right - upper quadrant abdominal pain, may have nausea, but urine changes like hematuria and increased specific gravity are not characteristic.
• Nephrotic syndrome: Characterized by massive proteinuria (not hematuria as a prominent feature), hypoalbuminemia, edema.
• Acute glomerulonephritis: May have hematuria, but often presents with hypertension, edema, and less likely to have the combination of back pain (unless there is associated obstruction - which is more common in renal calculi) along with chills (suggesting infection which can be associated with renal calculi causing obstruction and secondary infection).
• Renal calculi (kidney stones): Can cause back pain (flank pain), nausea (due to the pain and possible ureteral obstruction affecting the gastrointestinal tract via nerve pathways), chills (if there is an associated urinary tract infection due to obstruction). Hematuria (red blood cells from the irritation of the stone in the urinary tract) and increased urine specific gravity (due to possible dehydration from nausea and vomiting, or concentrated urine from reduced urine flow in case of partial obstruction).

Answer:

e) renal calculi