Recurrent Nephrolithiasis in Business Traveler

Case at a Glance

A 52-year-old male business traveler with a history of nephrolithiasis presented with acute left-sided flank pain while abroad, concerned about fitness for long-haul flight.

Patient's Story

The patient, a frequent business traveler, developed severe left-sided flank pain during a business trip to the UK. He had a previous history of right-sided kidney stones. The pain began acutely at night, causing him to 'roll around in agony' for several hours before subsiding temporarily. The pain recurred the following day but was more manageable with over-the-counter analgesics. He was scheduled for an 11.5-hour flight home and was concerned about his fitness to travel. He reported decreased urinary output but maintained normal urine color, increased water intake, and loss of appetite.

Initial Assessment

Patient presented as a well-appearing middle-aged male in mild distress. Vital signs stable with known hypertension controlled on medication. Physical examination revealed left costovertebral angle tenderness. The patient demonstrated appropriate pain management with oral analgesics and maintained adequate hydration status despite decreased appetite.

The Diagnostic Journey

Given the patient's history of nephrolithiasis and classic presentation of renal colic, imaging was prioritized. A non-contrast CT scan of the abdomen and pelvis was performed to evaluate for urolithiasis and assess stone burden.

Final Diagnosis

Nephrolithiasis with partial passage of calculi. CT imaging confirmed the presence of kidney stones with evidence that most stones had already passed, leaving only small residual fragments.

Treatment Plan

Conservative management with increased fluid intake (minimum 3 liters daily), pain management with prescribed analgesics, and patient education regarding stone passage. A fitness-to-fly medical clearance was provided for the patient's upcoming long-haul flight with specific instructions for in-flight hydration.

Outcome and Follow-up

Patient successfully passed the remaining stone fragments and was cleared for international travel. He was advised to follow up with his primary care physician upon return home for preventive measures and metabolic evaluation. The patient expressed satisfaction with the quality of care received and planned to continue increased fluid intake as a preventive measure.