Question

An X-ray of the lower abdomen shows a shadow in the region of the ureter suspected to be an ureteric calculus. A possible clinical symptom would be (a) acute renal failure (ARF) (b) anuria and haematuria (c) motor aphasia (d) chronic renal failure (CRF).

Short answer

The possible clinical symptom of an ureteric calculus would be (b) anuria and haematuria.

Step-by-step solution

Understanding ureteric calculus

Ureteric calculus (or ureteral calculi) refers to stones that are formed in the kidney and move down into the ureter. They can cause obstruction, leading to symptoms such as pain and other urinary issues.

Identifying possible symptoms

Given that the stones can obstruct the ureter, they can lead to an inability to urinate (anuria) and blood in the urine (haematuria). These are common symptoms of a kidney stone causing obstruction of the urinary tract.

Eliminating incorrect options

Motor aphasia is unrelated to urinary symptoms and is thus not a symptom of ureteric calculus. Acute and chronic renal failure can be consequences of long-standing obstruction but are less immediate symptoms than anuria or hematuria.

Key concepts

Urinary Tract Obstruction

Urinary tract obstructions are blockages that impede the normal flow of urine through its pathway from the kidneys to the urethra. This can result in a range of complications due to the backflow of urine, which can lead to kidney damage. One common cause of such obstruction is a ureteric calculus, a stone that forms in the kidney due to accumulated minerals and then moves into the ureter.

When such a stone blocks the ureter, it can cause severe pain known as renal colic. Symptoms may also include frequent urination, an urgent need to urinate, and discomfort during urination. The diagnosis is usually confirmed through imaging studies, such as an abdominal X-ray, ultrasound, or CT scan, revealing the presence of a stone.

Treatment for urinary tract obstruction due to ureteric calculus may involve pain management, medication to facilitate the passage of the stone, or surgical intervention in more severe cases.

Anuria

Anuria refers to a condition where there is a complete absence or severely reduced amount of urine output (<50 milliliters in a day). This can be a stark symptom of an acute urinary obstruction, such as when a stone completely blocks the urethra or the ureters.

It is a critical condition that can rapidly lead to an accumulation of waste products and fluid in the body, contributing to toxin buildup and electrolyte imbalances. If not treated promptly, it can lead to acute kidney injury or chronic kidney disease. Patients with anuria require immediate medical attention, and underlying causes such as ureteric calculus need to be addressed swiftly to prevent lasting kidney damage.

Haematuria

Haematuria is the medical term for the presence of blood in the urine, which can range from visible blood to microscopic levels that are only detectable with lab tests. This can be a symptom of various underlying conditions, including urinary tract infections, kidney disease, or trauma. However, it is also a well-recognized symptom of ureteric calculus.

The passage of the stone through the urinary system can cause irritation and damage to the lining of the ureters, bladder, or urethra, resulting in bleeding. While haematuria often causes alarm, it's important to undergo a proper diagnostic workup to determine the cause. Treatments vary based on the origin of the blood, but an immediate evaluation is necessary to address any potential obstruction.

Renal Failure

Renal failure signifies the kidneys' inability to adequately filter waste and fluids from the blood. It can be acute (ARF) or chronic (CRF), with ureteric calculus being a potential precursor to both if the obstruction lasts long enough to cause significant kidney damage.

Acute renal failure due to a single ureteric calculus is uncommon unless there is a blockage in a single functioning kidney or bilateral ureteral stones. Meanwhile, chronic renal failure is a slower process developing over months or years, potentially due to recurrent kidney stones or unresolved chronic obstructions.

Treatment of renal failure involves addressing the underlying cause, managing symptoms, and may include lifestyle changes, medication, dialysis, or a kidney transplant in severe cases.