A 20-year-old male presents with left-sided colicky pain and gross hematuria. He has a family history of kidney stones. An abdominal CT scan shows a left renal calculus composed of uric acid. What could be the underlying cause, and how should it be managed?
A potential underlying cause in this young patient with a family history of stones and a uric acid stone could be a metabolic disorder such as Lesch-Nyhan syndrome or a disorder of purine metabolism. Another possibility to consider is Gout, although it's less common in this age group. Evaluation should include a thorough history and lab work, including serum uric acid and 24-hour urine collection for uric acid, volume, pH, and creatinine. Management of uric acid stones involves hydration, dietary modification to reduce purine intake, urinary alkalization to pH 6-6.5, and potentially medications like allopurinol if the stones persist or recur.