Staghorn Calculus

kidney stone, also known as a renal calculus  is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine.  Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds).  Kidney stones are a significant source of morbidity.   80% of those with kidney stones are men.  Men most commonly experience their first episode between age 30–40 years, while for women the age at first presentation is somewhat later.
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Image from  Shanmugasundaram Rajaian, M.D., and Nitin Sudhakar Kekre, M.D. N Engl J Med 2009; 361:1486 October 8, 2009 (source)

A 58-year-old man presented with a 1-year history of painful urination. His medical history was notable for recurrent pyelonephritis on the right side.  Evaluation at this time revealed staghorn calculus (x-ray above) and left ureteric calculus, with mild renal failure . A urine culture was positive for Escherichia coli. Renal scanning with the use of 99mTc-labeled diethylenetriamine pentaacetic acid (DTPA) showed that both kidneys were functioning, with the right kidney performing more efficiently than the left.  After renal function was optimized by means of percutaneous nephrostomy and treatment with antibiotics, the patient underwent extended pyelolithotomy of the right kidney.  After surgery, renal function improved and has since remained stable, and the symptoms of painful urination abated.  Percutaneous nephrolithotomy and ureteroscopic lithotripsy on the left side are planned for future treatment.  Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. ( source: N Engl J Med 2009; 361:1486 October 8, 2009) 



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