If left untreated, staghorn calculi result in chronic infection and eventually may progress to xanthogranulomatous pyelonephritis 5. Staghorn calculi need to be treated surgically, usually PCNL (percutaneous nephrolithotomy) +/- ESWL (extracorporeal shockwave lithotripsy) and the entire stone removed, including small fragments, as otherwise, these residual fragments act as a reservoir for infection and recurrent stone formation. When viewed on bone windows they have a laminated appearance, due to alternating bands of magnesium ammonium phosphate and calcium phosphate 5. Staghorn calculi are radiopaque and conform to the renal pelvis and calyces, which are often to some degree dilated. Staghorn calculi (struvite stones) are a type of kidney stone that may occur with frequent kidney infections. The collecting system is filled with a densely calcified mass, producing marked posterior acoustic shadowing. The vast majority of staghorn calculi are radiopaque and appear as branching calcific densities overlying the renal outline and may mimic an excretory phase intravenous pyelogram. Uric acid and cystine are the underlying components of a minority of these calculi 5. Struvite accounts for approximately 70% of the composition of these calculi and is usually mixed with calcium phosphate thus rendering them radiopaque on both plain films and CT. Urease hydrolyzes urea to ammonium with an increase in the urinary pH 3-5. Proteus, Klebsiella, Pseudomonas and Enterobacter). Staghorn calculi are composed of struvite (chemically this is magnesium ammonium phosphate or MAP) and are usually seen in the setting of recurrent urinary tract infection with urease-producing bacteria (e.g. The majority of staghorn calculi are symptomatic, presenting with fever, hematuria, flank pain and potentially septicemia and abscess formation. Open surgical removal is the best option for treatment of complete staghorn calculi.Staghorn calculi are the result of recurrent infection and are thus more commonly encountered in women 6, those with renal tract anomalies, reflux, spinal cord injuries, neurogenic bladder or ileal ureteral diversion. Avoid nephrectomy in patients with bilateral disease. Injury to the kidneys is caused by obstruction, local infection, and infection of the renal parenchyma.Ī nephrectomy is indicated for the patient with a unilateral stone whose renogram shows very poor function. The stones grow rapidly and fill in, or make an internal cast of, the renal collecting system. The patient usually does not complain of pain, but loin ache may be present. In this setting, recurrent pyelonephritis is common. The bacteria are found within the interstices of the stone crystals therefore, the infection is very difficult to eradicate, and the rate of recurrence is high. The infective organism produces the enzyme urease, which splits urea to form ammonium ions, thus rendering the urine alkaline. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). These stones are caused by the action of bacteria the culprit may be Proteus, Klebsiella, Enterobacter, or Pseudomonas species. Staghorn calculus Stone in kidney Index to Diseases and Injuries References. A ureteral catheter (pigtail) had been placed in the pelvis of the left kidney to facilitate drainage.ĭrs Demetrios Papaioannides, Aphrodite Vlachopanou, Demetrios Cyrochristos, and Christos Tatsis of Arta, Greece, write that the calculi were triple-phosphate stones-composed of calcium, ammonium, and magnesium phosphate. The patient had a history of recurrent urinary tract infections caused by Proteus mirabilis. A roentgenogram of the kidneys, ureter, and bladder of a 58-year-old man shows bilateral stones in the renal pelvis and the renal calyces.
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