Clinical Scenario (from part 1)
Henry is a 60 year-old, white caucasian man who woke due to intense and worsening pain in his right flank this morning. He came to your emergency room in a state of distress, with diaphoresis (sweating) and pallor (pale appearance). He was unable to sit still or become comfortable in the ER cot, groaning and stating that he was nauseated. His past medical history includes diabetes, gout, and controlled hypertension. He takes medications for his diabetes, gout, and hypertension; he reports no difficulties in affording his medications and does not have difficulties in taking them as prescribed. His vital signs are as follows: temperature mildly elevated at 99.5℉, BP mildly elevated at 138/85, heart rate increased at 110, Respiratory rate normal at 20. His height is 5’9”, and his weight is 205 pounds; his BMI is 30.3

Treatment (from part 2)
You suspect that Henry has a renal stone. You order a renal CT (computed tomography) which reveals an obstructing stone in the renal pelvis of his right kidney. Urinalysis is also obtained. Henry is instructed that he will need to have a procedure to treat his condition, and consent is obtained.

Henry’s urinalysis: Normal values:
Color – red Yellow
Clarity/turbidity – clear Clear
pH – 5 4.5-8
Specific gravity – 1.021 1.005-1.025
Glucose – 90mg/dL ≤130 mg/dL
Ketones – absent absent
Nitrites – negative Negative
Leukocyte esterase – negative Negative
Bilirubin – negative Negative
Urobilirubin – 0.6mg/dL 0.5-1 mg/dL
Protein – none ≤150 mg/d
RBCs – 10RBCs/hpf ≤2 RBCs/hpf
WBCs – none ≤2-5 WBCs/hpf
Bacteria – none None

Rationale (part 3)
Renal stones are fundamentally a disorder of altered elimination, but they are impacted by an individual’s nutrition. As part of his education on preventing future stones, Henry needs to be educated on risk factors for stone formation. In a half page response, provide education for Henry on preventing the formation of future stones. There are several types of stones, each with its own risk factors, so be sure to individualize your response to Henry’s case.