Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
Author Affiliation: Dr Curhan is Associate
Professor of Medicine and Epidemiology, Harvard Medical School and Harvard
School of Public Health, Boston, Mass. He divides his time between the Channing
Laboratory and the Renal Division at Brigham and Women’s Hospital, Boston,
DR BURNS: Ms
P is a 44-year-old woman with a history of morbid obesity and superficial
thrombophlebitis who was diagnosed with kidney stones 1 month ago. She recently
lost her medical insurance and is applying for free care. She is currently
unemployed and lives with her daughter.
While on vacation in Jamaica, Ms P developed severe diarrhea without
nausea, vomiting, or fever. After returning to the United States her diarrhea
resolved, but she developed brown urine that lasted for several days. She
subsequently developed bilateral intermittent low back pain that she treated
with acetaminophen and ibuprofen with good relief. She denied any radiation
of the pain or any associated weakness or numbness. She had no fever, dysuria,
or urinary frequency. She never had similar symptoms in the past. She does
not smoke and denies alcohol use.
Curhan GC. A 44-Year-Old Woman With Kidney Stones. JAMA. 2005;293(9):1107-1114. doi:10.1001/jama.293.9.1107