Edit concept Question Editor Create issue ticket

Staghorn Calculus

Staghorn Calculus (m 30003)


Presentation

Urinary tract infection is considered the main risk factor for SC development and thus, affected individuals typically have a medical history of urinary stasis or recurrent infection. Most SC correspond to so-called "infection stones" composed of magnesium ammonium phosphate/struvite, which are characterized by very rapid growth [4] [5]. Indeed, complete SC may form within little more than a month [6]. They rarely pass spontaneously and provoke clinical symptoms in the vast majority of cases. Patients may claim flank pain and constitutive symptoms like fever, nausea and vomiting. SC may be associated with sepsis.

Diagnostic measures may reveal the following:

Recurrence is likely [4]. If particles of renal calculi remain in the renal pelvis after therapy, they may serve as nuclei for renewed crystallization. Thus, a medical history of urolithiasis should prompt a suspicion of SC and other types of renal calculi.

Recurrent Urinary Tract Infection
  • Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. Shanmugasundaram Rajaian, M.D. Nitin Sudhakar Kekre, M.D. Christian Medical College, Vellore, India[nejm.org]
  • They are typically encountered in patients with recurrent urinary tract infections.[svuhradiology.ie]
  • 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.[radiopaedia.org]
Constitutional Symptom
  • Patients may claim flank pain and constitutive symptoms like fever, nausea and vomiting. SC may be associated with sepsis.[symptoma.com]
  • If the kidney is completely nonfunctional at diagnosis, nephrectomy may be performed. 2,6 Diagnosis Xanthogranulomatous pyelonephritis Summary Patients with flank pain, constitutional symptoms, and urinary complaints that have failed conservative management[jaocr.org]
Dentist
  • It should be removed regularly by a dentist or dental hygienist; if neglected, it can cause bacteria to lodge between the gums and the teeth, causing gum infection, dental caries, loosening of the teeth, and other disorders.[medical-dictionary.thefreedictionary.com]
Lymphadenopathy
  • We had not done computerized tomography in our patients, and retrospectively feel that in first patient we could have identified lymphadenopathy on the computerized tomography.[bmcurol.biomedcentral.com]
Pelvic Mass
  • Recently sonographic finding of markedly enlarged and hydronephrotic kidney with obstructive calculi, stigmata of pyonephrosis and, anechoic pelvic mass, extending in calyces is found to help in preoperative diagnosis of associated urothelial malignancy[bmcurol.biomedcentral.com]
Abdominal Mass
  • Abdominal mass in new born. Multicystic dysplasia of crossed fused renal ectopia-ultrasound demonstration.” J Urol 131: 1160-1161. Kelalis, P. P., R. S. Malek, et al. (1973). “Observations on renal ectopia and fusion in children.”[urotoday.com]
Ejection Murmur
  • She had a 2/6 systolic ejection murmur. Abdomen was soft with a well-healed midline abdominal incision. There was no costovertebral tenderness bilaterally. PCNL tract on the left showed a well-healed scar. There was 1 peripheral edema.[liebertpub.com]
Impulsivity
  • Due to the higher power normally used (2000-4000 shock waves) in the standard equipment, we made some changes to minimise the impulse rate (bringing bags of water). Figure 3 Progressive fragmentation of the calculus after ESWL sessions.[scielo.mec.pt]
Urinary Dribbling
  • “Detection of poorly functioning malpositioned kidney with single ectopic ureter in girls with urinary dribbling: imaging evaluation in five patients.” AJR 164(4): 957-961. Chang, T. D. and S. P. Dretler (1996).[urotoday.com]

Workup

The presence of SC is usually confirmed by means of diagnostic imaging. While most SC are readily observable in images obtained by plain radiography and sonography, computed tomography scans have largely replaced the former: Computed tomography scans allow for an assessment of the overall stone burden, the condition of the renal pelvis and its calyces [9]. Of note, this technique permits for a reliable estimation of a small calculus' volume, but such measures have proven less precise in case of large, branched calculi. The three-dimensional reconstruction of SC may help to resolve this issue [10].

Additionally, laboratory analyses of blood and urine samples should be performed. The former should include measurements of serum electrolyte concentrations, urea and creatinine, and results may not only reveal renal function impairment but also metabolic pathologies that predispose for the development of renal calculi. With regards to urine analyses, the vast majority of SC patients presents with microscopic hematuria and crystalluria. The morphology of urine crystals may indicate the composition of the renal calculus and since most SC are composed struvite [4], "coffin lids" are typically seen upon the microscopic examination of urine sediment. In case of a concomitant urinary tract infection, leukocytes and bacteria may be detected.

Pneumoperitoneum
  • Alster C, Zantut LF, Lorenzi F et al (2007) An unusual case of pneumoperitoneum: nephrocolic fistula due to giant renal staghorn calculus. Br J Radiol 80:e1–e3 PubMed CrossRef Google Scholar 2.[link.springer.com]

Treatment

  • No patient with complete clearance of fragments died of renal related causes compared to 3% of those without clearance of fragments and 67% of those who refused treatment (p 0.001).[ncbi.nlm.nih.gov]
  • DMSA renal scan performed at 24 months after her last ESWL treatment was normal. Figure 4 Following last ESWL treatment, the child is free of nephrolithiasis, as shown by X-ray.[scielo.mec.pt]

Prognosis

  • However, complete staghorn calculus is rare in polycystic kidney disease and predicts a gloomy prognosis of kidney.[ncbi.nlm.nih.gov]
  • Treatment and prognosis 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[radiopaedia.org]

Etiology

  • Its etiology is associated with urinary tract infection (UTI) caused by bacteria which produce ureases.[scielo.br]
  • Staghorn Calculus – Etiology, Management & Prevention 2.[slideshare.net]
  • […] blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology[decs.bvs.br]
  • Crystallographic analysis of retrieved calculus remnants can help identify the underlying etiology and may obviate a complete metabolic evaluation.[aafp.org]

Epidemiology

  • Epidemiology • Infection stones comprise 5% to 15% of all stones • More often in women (ratio of 2 : 1) Increased risk for infection calculi: 1.[slideshare.net]
  • Qualificadores Permitidos Inglês : BL blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology[decs.bvs.br]
  • The overwhelming majority were women, a statistic that has been shown in previous epidemiologic studies of staghorn calculus.[scielo.br]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • The majority of cases occur in people Aug 18, 2016 The present article reviews the epidemiology, pathophysiology and potential treatment of urolithiasis. Oxalate is an essential amino acid and must be included in the diet.[beylikduzuwebtasarim.com]
Sex distribution
Age distribution

Pathophysiology

  • Possible mechanisms of pathophysiology have been discussed.[ncbi.nlm.nih.gov]
  • Kidney stones (also called renal calculi, nursing lecture on kidney stones symptoms, treatment, pathophysiology, and causes for the NCLEX exam.[beylikduzuwebtasarim.com]

Prevention

  • As staghorn calculi are associated with kidney fibrosis and high long-term renal deterioration rate, prompt control of urinary tract infection in polycystic kidney disease patient will be beneficial in preventing staghorn calculus formation.[ncbi.nlm.nih.gov]
  • It is fundamental to correct metabolic disorders and control urinary infection in order to prevent recurrence of these calculi. Prevention is particularly difficult in these patients with recurrent infections.[scielo.br]
  • Staghorn Calculus – Etiology, Management & Prevention 2.[slideshare.net]

Summary

Staghorn calculus (SC) is a branched renal calculus that occupies the renal pelvis and at least two the major calyces. SC may fill large parts of the collecting system, though, and partial calculi may be distinguished from complete calculi according to their size and morphology. In this context, the following classification system has been proposed years ago [1]:

  • Borderline SC fill the renal pelvis and one major calyx
  • Partial SC fill the renal pelvis and two major calyces
  • Complete SC occupy the renal pelvis and all major calyces or at least 80% of the collecting system
  • Gigantic SC fill the whole collecting system and provoke its dilation

From a clinical point of view, it is important to assess the overall stone burden, the involvement and compromise of components of the collecting system, and possible renal function impairment. SC may be associated with life-threatening conditions like end-stage kidney disease and sepsis. In order to prevent these complications and because the incomplete removal of the renal calculus is likely to result in renewed urolithiasis, it is of utmost importance to assure the complete elimination of SC by means of extracorporeal shock wave therapy, percutaneous nephrolithotomy, retrograde ureteroscopic stone disintegration, open surgery, or any combination thereof [2]. Percutaneous nephrolithotomy is commonly recommended as first-line treatment [3].

References

Article

  1. Di Silverio F, Gallucci M, Alpi G. Staghorn calculi of the kidney: classification and therapy. Br J Urol. 1990; 65(5):449-452.
  2. Rassweiler JJ, Renner C, Eisenberger F. The management of complex renal stones. BJU Int. 2000; 86(8):919-928.
  3. Healy KA, Ogan K. Pathophysiology and management of infectious staghorn calculi. Urol Clin North Am. 2007; 34(3):363-374.
  4. Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional Management of Kidney Stones (Nephrolithiasis). Clin Nutr Res. 2015; 4(3):137-152.
  5. Krambeck AE, Lieske JC. Infection-related kidney stones. Clinic Rev Bone Miner Metab 2011; 9: 218.
  6. Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol. 2014; 11(6):333-341.
  7. Zaid UB, Porten SP, Cinman NM, Sanford TH, Breyer BN. Xanthogranulomatous pyelonephritis presenting with a left flank mass. Case Rep Med. 2013; 2013:362194.
  8. Tsukagoshi D, Dinkovski B, Dasan S, Jethwa J. Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous abscess. Cjem. 2006; 8(4):285-288.
  9. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008; 28(1):255-277; quiz 327-258.
  10. Li H, Chen Y, Liu C, Li B, Xu K, Bao S. Construction of a three-dimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. World J Urol. 2013; 31(6):1587-1592.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 11:48