A 70-YEAR-OLD WOMAN FROM DANAO

CITY WITH MEDICAL DIAGNOSIS OF

OBSTRUCTIVE UROPATHY SECONDARY
TO NEPHROLITHIASIS

RESEARCHERS:
ALEXHIA PETTE A. ZAMORA
KATRINA MARIE D. CHAN
MIKAELA G. CASAS

RESEARCH ADVISER:
MR. NIÑO IAVAN G. MANINGO

INTRODUCTION
 This study is related to a case of a 70 year old female from Danao City medically diagnosed with

obstructive uropathy secondary to nephrolithiasis. This aims to elaborate further the description of the

disease process and to possibly trace the etiology or the cause of the disease thereby arriving at the best

preventive measures or strategies to avoid having such disease. The disease obstructive uropathy is a

disorder of the urinary tract that occurs due to obstructed urinary flow caused by nephrolithiasis which are

commonly known as renal calculi or kidney stones. Urinary stones may develop at any level in the urinary

system but are most frequently found within the kidney. Nephrolithiasis are commonly reffered to as renal

calculi or kidney stones. Kidney stones are primarily made of crystalline component, which requires three

major steps for formation: nucleation, growth and aggregation. Nucleation starts or seeds the stone on

process and may be initiated by a variety of materials such as protein, foreign bodies or cystals. The initial

crystal serves as the core for further growth and aggregation. It is now believed that persons who form

stones may lack inhibitor substances in the urine that naturally slow or inhibits stones formation. Although it

was once thought that a calcium-restricted diet would reduce the risk of recurent calcium stone formation,

studies have shown that in some patient a low calcium diet would increase the risk for recurrent stone

formation. Pain associated with the passage of kidney stone (renal calculi) is reffered to as renal colic. Pain is

the primary symptom in an acute episode of renal calculi. The classic presentation is sudden onset of severe

flank pain usually combined with tenderness over the costovertebral angle. Radiation of the pain may

indicate the location of the stones in the urinary tract. For example, if the stone is in the kidney pelvis, the

pain caused by hydronephrosis and is more dull and constant in character, occurring primarily in the

costovertebral angle. As the stone moves down the ureter, excruciating and intermittent pain is caused by

spasm of the ureter and anoxia of the ureter wall from the pressure of the stone.

REVIEW OF RELATED LITERATURE

 A kidney stone forms when urine is supersaturated with a stone forming salt. The mineral

composition of renal calculi varies. Approximately 75% of renal stones consist of calcium salts (oxalates or

phosphates), and the remaining stones are composed of struvite, uric acid or cystine. Risk factors can be

identified in 90% of persons with kidney stones. In addition to inadequate hydration, risk factors for the

development of calcium stones include hypercalciuria and high protein and sodium intake. UTIs increase the

risk of developing struvite stones. Excess intake of dietary purine found red meat, fish and poultry and a

disorder in purine metabolism are primary risk factors for formation of uric acid stones. Although rare, an

autosomal recessive inheritance of homocystinuria can cause development of cystine stones. Estimates

indicate that kidney stones effect about 720,000 people in the united states each year and account for 7 to 10

every 1000 hospital admissions. Renal calculi have a recurrence within 5 years. Despite the increased

awareness of the importance of health literacy in kidney care, there have been few studies examining health

literacy inpatients with chronic kidney disease not on dialysis .Wright etal reported an 18 prevalence of limited

health literacy in a single cohort of 401 patients with CKD stage 1-5 in an outpatients study.In study,limited

health literacy based on the REALM was associated with poorer CKD knowledge.Another study of 2340

patients with mild-moderate CKD reported a prevalence of limited health literacy of 28% in non-hispanic

black and 5% in non-hispanic white.This study use the S-TOFHLA as a tool to measure health literacy had

lower estimated glomerular filtration rate (eGFR) (34 mL/min vs 42 ml/min per 1.73m2) higher urine

protein /24 h(0.31 g vs 0.15 g)a higher self-reported cardiovascular disease (61% vs 37%) and were less likely

to have blood pressure <130/80 mmHg(51% vs 58%).Finally ,devraj etal also found an association of limited

health literacy with kidney function.In a small study of 150 patients with CKD stage 1-4 every unit increase in

newest vital sign score was associated with a 1.9% increase in eGFR . Further studies are needed of health

literacy in patients with earlier stages of kidney disease, since their care and needsare different than those with

more advanced disease. Chronic kidney disease,also called chronic kidney failure,describegradual loss of

kidney function.Your kidney filter wastes and excessfluids from your blood,which are then excreted in your

urine.When chronic kidney disease reaches an advanced stage,dangerous levels of flui,electrolytes and wastes
can build up on your body.In the early stageof chronic kidney disease,you may have few signs or

symtoms.Chronic kidney disease may not become apparent until your kidney function is significantly

impaired.Treatment for chronic kidney disease focuses on slowing the progression of the kidney

damage,usually by controlling the eunderlying cause.Chronic kidney disease can progress to end-stage kidney

failure,which is fatal without artificial filtering (dialysis)or a kidney transplant.

METHODOLOGY
 Who discovered kidney disease? The study of kidney disease was furthered by William Howship

Dickinson's description of acute nephritis in 1875 and Frederick Akbar Mahomed's discovery of the link

between kidney disease and hypertension in the 1889 Where was the kidney disease discovered?Mahomed's

original sphygmograph, created when he was a medical student, was improved in 1896 by Scipione Riva-

Rocci, of Italy, with the use of a cuff to encircle the arm. In the twentieth century, investigators such as

Homer Smith revealed the underlying physiology of the kidney.Where does the kidney disease originate? -

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible

for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to

many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes.What is

the country that has the highest kidney disease?In Russia, the prevalence rate for chronic kidney disease was

12,832 per 100,000 population in 2017, compared to 5,687 per 100,000 population in Germany What is the

main cause of kidney disease? Diabetes and high blood pressure are the most common causes of chronic

kidney disease (CKD).Who is more prone to kidney disease? Black or African Americans are almost 4 times

more likely and Hispanics or Latinos are 1.3 times more likely to have kidney failure compared to White

Americans. Minority populations have much higher rates of high blood pressure, diabetes, obesity and heart

disease, all of which increase the risk for kidney disease.How long can you live on dialysis?Someone who

starts dialysis in their late 20s can expect to live for up to 20 years or longer, but adults over 75 may only

survive for 2 to 3 years. But survival rates of people on dialysis have improved over the past decade and are

expected to continue improving in the future.

RESULTS AND DISCUSSION

The chosen respondent was Mrs. Nora G. Chan, a 70 year-old female. Living at Beatriz village, Poblacion,

Danao City. Mrs Nora is the daughter of Mrs. Charing Giango and Mr. Delfin Giango. She is a mother of two

boys which are Mr. Doniel Chan and Mr. Steven Chan and her husband is Mr. Perfecto Chan.

FAMILY BACKGROUND

The patient mentioned that both her parents were disease free due to their living style they always eat

healthy and drinks less carbonated drinks. Both her parents are not a fan of eating unhealthy foods so Mrs.

Nora obviously got her illness due to her unhealthy eating habit and also because she always skips meal
because of her business which is the ukay2x or thrifted clothes. Thankfully both her sons did not have that

disease genetically and remained safe since they do not have the same lifestyle with Mrs. Chan.

BRIEF MEDICAL HISTORY

This disease problem actually began few years back with chief complaints of having back pain, flank pain

and groin pain. Then, there had been episodes of fever and chills which was initially diagnosed as UTI urinary

tract infection. The patient’s UTI recurred often for at least 4-5 times since 2019, and each time she was

treated with antibiotics and there were a couple of times that she was hospitalized and treated UTI through

intrauenous injections or through a dextrose line or IV line until it was discovered that the patient was having

kidney stones the reason for her recurring UTIs. Then she had to see a doctor that specializes in kidney

problems, s Urologist and that was the time when she had experiences severe pain and was chilling and had

convulsive fever. She had been admitted at UCMED and diagnosed with obstructive uropathy secondary to

nephrolithiasis was cared in the Intensive Care Unit. ICU for 4-5 days and it was then that she had undergo a

surgical procedure called nephrostomy insertion wherein a nephrostomy tube was inserted to dran the urine

from her kidney to the attached wire bag. The patient became stable and was allowed to go home still with

the nephrostomy tube attached to her side and along comes a great responsibility in family care of the

nephrostomy site that needs dressing the wound every 2 days and flushing the tube with plain NSS (dextrose

water) twice a day to keep the tube patient. Then, care should be done to the patient not to get it infected

while doing her daily hygiene care and tasks. The nephrostomy tube is them checked by the doctor every

now and then during medical check ups at UCMED and the nephrostomy tube changed every 3 months. The

patient hopefully underwent a nephrostogram for the urologist to make sure that her condition improved

and that the kidney stones are not obstructing the flow of wire before deciding whether to remove the tube
or not. At present, the patient is at home, still with her nephrostomy tube inserted and hopefully waiting for

improvement for her condition.

(THE FOLLOWING PHOTOS ARE PROOFS AND RESULTS OF HER SAID MEDICAL HISTORY)

FOOD AND LIFESTYLE

The patient’s lifestyle before she got ill was so stressful and unhealthy in the sense that she was engaged in a

very timesome business of selling ukay2x, aside from extraneous lifting of heavy baggages, she became so

busy that in times, she misses her meals and drinks less water in a day also stopping her urge to urinate until

forgetting to do so. The patient was unable to eat well-balanced diet due to her nature of work/living as well,

She skips to have breakfast and have a couple of bread with a cup coffee every morning instead. Tired of
working under the heat of the sun, the patient after drinks carbonated soda or cold soft drinks to ease her

thirst. Also, she is fond of eating hi-fat pork and oily foods with rice and finishes it off with soda or soft drinks.

She also liked to eat salted fish cooked with monggo soup, pork barbeque, liver, chicken intestines and skin. It

is not after that she could eat vegetables, only when there’s available in the restaurant where the often buy

their precooked dinner food, everytime more soft drinks were drank than water. It was only lately that the

patient realized that she had to drink more water and no carbonated drinks at all. Moreover, the patient is

not a smoker and not an alcohol drinker she also did not engage to regular exercise its just that she had

obviously practiced unhealthy lifestyle before she got sick.

CONCLUSION

Based on the data gathered, it is therefore concluded that living an unhealthy lifestyle and eating an

unbalanced diet can be considered as the causative factors in having an obstructive uropathy secondary to

nephrolithiasis.