A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnosed renal calculi and ordered flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
A. Kidney
B. Ureter
C. Bladder
D. Urethra
Correct Answer: A. Kidney
The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. They occur in one in 11 people at some time in their lifetimes with men affected 2 to 1 over women.
Option B: Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity.
Option C: Urolithiasis occurs when solutes crystallize out of urine to form stones. Urolithiasis may occur due to anatomic features leading to urinary stasis, low urine volume, dietary factors (e.g., high oxalate or high sodium), urinary tract infections, systemic acidosis, medications, or uncommonly genetic factors such as cystinuria.
Option D: The most common cause of stone disease is inadequate hydration and subsequent low urine volume. The other four most common factors contributing to urinary stone formation are hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia. The ureter, bladder, and urethra are less common sites of renal calculi formation.
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