ROS- He denies any fevers, chills, decrease in urine output, gross hematuria, feeling ill, nausea, or vomiting.
A/P- M w/history of nephrolithiasis who presented to ED last Friday after R sided flank pain, bloody urethral discharge and burning after sexual intercourse. Flank pain and discharge have resolved since ED visit and patient now is asymptomatic aside from 2/10 CVT discomfort on palpation. Negative GC/CT. Consistent w/passage of stone (likely calcium oxalate) after sexual intercourse. Continue to monitor patient and provide anticipatory diet guidance. Considered obtaining repeat UA, CMP, but in light of resolved symptoms and lack of patient desire, will observe w/no labs at this time.
Calcium Oxalate stone prevention plan.
-Recommended sufficient fluid intake distributed throughout the day to produce at least 2 liters of urine per day, including drinking at night
-Avoid excessive animal protein in the diet. A high-animal protein diet is a risk factor for renal stones in men.
-Several servings of dairy or other calcium-rich foods to reach 800 to 1000 mg/day are encouraged.
-Limiting dietary sodium.
-Limiting dietary sucrose and fructose.
-Can consider use future use of thiazide diuretics for reducing urinary calcium excretion if patient has recurrent symptoms. Per guidelines, among those with calcium oxalate stones, drug therapy is indicated if there is continued stone formation or if there is insufficient improvement in the urine chemistries despite attempted dietary modification over a three- to six-month period. The aim of therapy is to prevent further calcium oxalate precipitation.
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