Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief.
In this discussion:
1. Discuss with your colleagues the pathophysiological development of nephrolithiasis.
2. Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
3. Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
Include citations from the text or the external literature in your discussions.