Case history
Case history #1
A 35-year-old woman presents with severe left-sided flank pain. She has had mild left-sided back pain previously and urinary tract infection (UTI). A few days ago she was given antibiotics by her primary care physician for a presumed UTI. On physical exam, the patient is afebrile with a blood pressure of 135/85 mmHg. She has no suprapubic tenderness with mild costovertebral angle tenderness on the left. Urinalysis dipstick reveals a urine pH of 6.0 and 2+ positive for blood.
Case history #2
A 47-year-old man presents with asymptomatic microscopic hematuria. His medical history is notable for hypertension treated with an angiotensin 2 converting enzyme inhibitor. His blood pressure is 130/80 mmHg. There is no flank or suprapubic tenderness. Prostate exam reveals a smooth, slightly enlarged gland. Urinalysis dipstick reveals a pH of 6.0, 4+ blood, and 1+ protein.
Other presentations
MSK may occur with other congenital defects such as hemihypertrophy (enlargement of one side of the body), Beckwith-Wiedemann syndrome (congenital overgrowth syndrome), Caroli disease (fibropolycystic liver disease), congenital hepatic fibrosis, autosomal dominant polycystic kidney disease, and Ehlers-Danlos syndrome (connective tissue disorder).[3] MSK may also be associated with primary hyperparathyroidism.[4] Atypical presentations include chronic kidney disease due to repeated episodes of pyelonephritis and struvite (magnesium ammonium phosphate) kidney stones.[5][6][7]
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