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Kidney Stones - What's the diagnosis?

Posted Jul 12 2013 12:00am
A 65yo man was reviewed in the clinic for assessment of kidney stones. He has a history of stones for at least 8 years and has been passing small calculi on a regular basis for the last few months. His 24 hour urine results are shown below (results are 24 hour total values unless otherwise specified)

Volume, Liters Sodium, mmol/day Supersaturation Calcium Oxalate 10.11 Potassium, mmol/day 45 Calcium, mg/day 78 Magnesium, mg/day 52 Oxalate, mg/day 28 Phosphate, mg/day 0.76 Citrate, mg/day 11 NH4, mmol/day 68 Supersaturation Calcium Phosphate 0.71 Chloride, mmol/day 48 Urine pH 5.6 Sulphate, mEq/day 39 Supersaturation Uric Acid 2.71 Urea Nitrogen, g/day 11 Uric Acid, mg/day 0.499 Protein Catabolic Rate 1.2 Creatinine 1292

0.71 7

He has a high risk for calcium oxalate and uric acid stones. His urine citrate and sodium are remarkably low and he has a very low urine volume. His BP in the clinic was normal as were his labs apart from a serum creatinine of 1.3mg/dl

What is the underlying diagnosis (an important  piece has been left out of his background history)?
What is the best approach to treating his kidney stones?

Answers in the comments please (if this proves popular we may make it a regular feature).

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