Unilateral staghorn calculus

Asher K George MPH

Corresponding author: Asher George
Contact Information: Asher.K.George@ttuhsc.edu
DOI: 10.12746/swrccc.v10i44.1073

Staghorn renal calculi can branch out and fill the whole renal pelvis and collecting system, causing obstructive and infective symptoms in patients.1 Staghorn stones get their name from the space-filling shape found on imaging and gross renal evaluation, which resembles antlers on a deer, and have also been referred to as coral calculi.2 These stones typically present unilaterally and are often composed of struvite (magnesium ammonium phosphate) or calcium carbonate appatite.2 A common etiology of struvite stones involves alkalization of urine from increased urinary ammonia, usually due to the presence of a urease-producing microorganism.3 The urease found in these organisms splits urinary urea into ammonia, which then hydrolyzes to bicarbonate and ammonium.3

The image displays a 5.0 cm × 3.5 cm staghorn calculus that nearly encompasses the entire left renal pelvis and calyceal system (Figure). The first-line management of staghorn calculi includes percutaneous nephrolithotomy; secondary options include percutaneous nephrolithotomy with extracorporeal shock wave lithotripsy or ureteroscopy with laser lithotripsy.3 To prevent staghorn calculi recurrence, patients should adhere to a low phosphate and calcium diet paired with an estrogen supplement in women and aluminum gel. In addition, acetohydroxamic acid, a urease inhibitor, has proven useful to interrupt struvite stone growth but does carry the risk of serious systemic side effects, such as hemolytic anemia, myelosuppression, and superficial thrombophlebitis.3


Figure

Figure. Noncontrast CT displaying left renal staghorn calculus.


Keywords: staghorn calculus, struvite, urease


REFERENCES

  1. Klein I, Gutiérrez-Aceves J. Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi. Asian J Urol. 2020;7(2):87–93.
  2. Xiang H, Han J, Ridley WE. Staghorn calculus. J Med Imaging Radiat Oncol. 2018;62 Suppl 1:111. doi:10.1111/1754-9485.54_12784
  3. Diri A, Diri B. Management of staghorn renal stones. Ren Fail. 2018;40(1):357–362.


Article citation: George AK. Unilateral staghorn calculus. The Southwest Respiratory and Critical Care Chronicles 2022;10(44):64
From: School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 7/10/2022
Accepted: 7/12/2022
Conflicts of interest: none
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