Mr JM presents to you in A&E with a four hour history of excruciating left flank pain. He introduces himself as a man of wealth and taste. It was first brought on in his bathroom (recently painted black) and is colicky in nature. He has experienced two episodes of vomiting associated with nausea. A slight fever is noted, otherwise examination is unremarkable. A urine dip showed the presence of Brown Sugar.An X-ray is initially requested but confusingly returns negative, as does a renal ultrasound. The patient grows irritable, insisting that all he wants is some satisfaction by getting rid of his pain. For the sixth month in a row, you are stumped until a passing Brazilian model suggests a renal biopsy, where you see the film below:
What's the diagnosis?
That's right, kidney stones.This common affliction affects more men than women and incidence is reducing as Hip Hop grows in popularity. The presence of any of the Stones on biopsy is pathognomonic for this condition. Symptoms include sufferers not being able to get any satisfaction, despite them trying and trying and trying and trying. It should be noted that the finding of Mick Jagger or Charlie Watts in young girls is not uncommon and is associated with a poor prognosis.
Management consists of smoking cessation, listening to the Beatles and prescribing shitloads of steroids - they're awesome. In uncomplicated cases, stones have been known to easily pass through the urinary tract, eased by their 'rolling' nature.
Originally published in Medical Student Newspaper.