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:

• Hydronephrosis
• Pyonephrosis
• Xanthogranulomatous pyelonephritis [7]
• Perinephric abscess [8]

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.

• Pain

  CASE PRESENTATION A 25-year-old Hispanic female presented to the emergency department (ED) with two weeks of waxing and waning right-sided flank pain. [westjem.com]

  Symptoms are again nonspecific and include fever, malaise, flank pain and hematuria.2,5 CT is the primary imaging modality in evaluating the extent of disease. [jaocr.org]

  In conclusion, xanthogranulomatous pyelonephritis should be considered in afebrile children with flank pain and staghorn calculus. [ncbi.nlm.nih.gov]

  Most of them are symptomatic and patients may present with fever, hematuria, flank pain and back pain. They are associated with recurrent UTI and if left untreated, pyonephrosis and obstructive uropathy will develop. [drrahmanxrays.com]

• Fever

  Symptoms are again nonspecific and include fever, malaise, flank pain and hematuria.2,5 CT is the primary imaging modality in evaluating the extent of disease. [jaocr.org]

  She was observed closely with prompt resolution of the tachycardia and fever, and her symptoms were attributed to transient bacteremia from surgical instrumentation. [hindawi.com]

  Whereas fever, hemothorax, hydrothorax, paralytic ileus were encountered in 12%,0.5%,0.5% and 4% patients respectively. Conclusion: For staghorn calculus PCNL is safe and effective procedure with acceptable morbidity and without mortality. [worldwidejournals.com]

  Her fever reduced, and her inflammation markers decreased. The next month, she visited our department again for fever. CT revealed that her middle and inferior calyx had not been adequately drained (Fig. 2). [karger.com]

  Fever (36%) was the most common postoperative complication. The mean cortical thickness increased to 10.68 mm at third month of follow-up, compared to 9.26mm before surgery. The mean preoperative Hb was 10.84gm/dl. [annalskemu.org]

• Sepsis

  Sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. Sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. [ncbi.nlm.nih.gov]

  SC may be associated with life-threatening conditions like end-stage kidney disease and sepsis. [symptoma.com]

• Recurrent Urinary Tract Infection

  They are typically encountered in patients with recurrent urinary tract infections. [svuhradiology.ie]

  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]

  […] catheter and recurrent urinary tract infections to look for another cause of recurrent infections. [gmjournal.co.uk]

  Staghorn calculus may be associated with recurrent urinary tract infections and renal failure. ( source: N Engl J Med 2009; 361:1486 October 8, 2009) Other similar posts [anatomybox.com]

• Surgical Procedure

  In most cases with urinary tract calculi, the method has replaced the classic surgical procedure. [ncbi.nlm.nih.gov]

  Of these patients 76 underwent PNL (group-I), 35 sandwich (group-11) and 45 open surgical procedures (group-III). [indianjurol.com]

  A percutaneous nephrolithotomy is a surgical procedure that requires an incision in the back. The surgeon will then insert small instruments into the kidney to remove the stones. Related wiseGEEK Articles [wisegeekhealth.com]

  Operatively, retrograde irrigation should be limited during the surgical procedure. [hindawi.com]

  Both the EUA and AUA recommend antibiotic therapy in the presence of a suspected struvite stones with associated infection; however, while antibiotics are typically given for 1 to 2 weeks prior to the planned surgical procedure, high-level guidelines [liebertpub.com]

• Fracture

   Recurrent stone formers  Strong family history of stones  Intestinal disease (particularly chronic diarrhea)  Pathologic skeletal fractures  Osteoporosis  History of urinary tract infection with calculi  Personal history of gout  Infirm health [slideshare.net]

  The patient had lost his left leg and left kidney, and had suffered a pelvis fracture in a car accident 10 years prior. PCNL is recommended for kidney stones larger than 2.0 cm and was therefore preferable. [tau.amegroups.com]

• Suggestibility

  In each patient, the plain abdominal radiograph showed a fragmented staghorn calculus, which is suggested as a radiological sign of pyonephrosis and indicative of the need for surgical attention. [ncbi.nlm.nih.gov]

  Third, we suggest that total operative time be limited to under 90 minutes of lithotripsy per stage. We also suggest that careful consideration be given to the consistency of the stone at the onset of fragmentation. [hindawi.com]

• Altered Mental Status

  In the elderly symptoms such as generalized weakness, altered mental status and malaise could be the first signs of the illness. A patient’s vital signs may be the most useful physical exam finding in diagnosing those with pneumonia. [ncbi.nlm.nih.gov]

• Renal Insufficiency

  Conclusion: Staghorn stones if left untreated lead to chronic UTI & renal insufficiency. Removal of the stone is the only way these consequences can be avoided. [annalskemu.org]

  상병코드 한글상병명 영문상병명 N19 신부전 NOS Renal insufficiency NOS N19 요독증 NOS Uremia, NOS N20 신장 및 요관의 결석 Calculus of kidney and ureter N20 결석성 신우신염 Calculous pyelonephritis N200 신장의 결석 Calculus of kidney N200 신장결석증 NOS Nephrolithiasis, NOS N200 신장결석 Renal calculus [druginfo.co.kr]

  No treated, staghorn stone can cause septicemia, chronic renal insufficiency, destruction of kidney by infection and chronic calicial dilatation. [panafrican-med-journal.com]

  Most ureteral stones smaller than 5 mm in diameter pass spontaneously within 4 weeks of the onset of symptoms. 25,32 In patients who have stones smaller than 1 cm, whose pain is controlled, and who show no evidence of sepsis or renal insufficiency, a [mdedge.com]

  Urology; 85(1):69-73. 3) Kuzgunbay B, Gul U, Turunc T, Egilmez T, Ozkardes H, Yaycioglu O. (2010) Long-term renal function and stone recurrence after percutaneous nephrolithotomy in patients with renal insufficiency. [thecalculator.co]

• Kidney Failure

  Failure Risk Calculator Kidney Failure Risk Calculator Nephrology Self Assessment Quiz Nephrology Self Assessment Quiz Nephrology Nutrition Nephrology Nutrition Images in Nephrology Images in Nephrology Nephrology Articles Nephrology Articles Nephrology [ukidney.com]

  The way that these stone branches grow can block the pelvis and the calyces of your kidney. This can lead to kidney failure. The renal pelvis and calyces are the names of the drainage system for urine (pee) within your kidney. [my.clevelandclinic.org]

  The adequate and early treatment is directly associated with the maintenance of renal function; therefore, the information presented here is very useful to avoid complications, such as kidney failure in children. REFERENCES Horuz R, Sarica K. [redalyc.org]

  […] disease; and All children 2 years with kidney disease/failure, chronic cerebrospinal fluid leak, HIV infection and other immunosuppressive conditions. [eportal.mountsinai.ca]

  4 (severe) N18.5 Chronic kidney disease, stage 5 N18.6 End stage renal disease N18.9 Chronic kidney disease, unspecified N19 Unspecified kidney failure N20 Calculus of kidney and ureter N20.0 Calculus of kidney N20.1 Calculus of ureter N20.2 Calculus [icd10data.com]

• Renal Injury

  Google Scholar 44 : Microdialysis assessment of shock wave lithotripsy-induced renal injury. Urology2000; 56: 364. Google Scholar 45 : Shock wave lithotripsy-induced renal injury. Am J Kidney Dis1991; 17: 445. [auajournals.org]

• Renal Function Impairment

  The clinicians well know how surgical treatment of staghorn calculosis is technically hard to perform, since there is a risk of renal blood vessels injuries and renal function impairment. [ncbi.nlm.nih.gov]

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.

• Nephrolithiasis

  Nephrolithiasis (kidney stones) Renal calculus Renal calculus w ureteral calculus Staghorn calculus Staghorn calculus (kidney stone) 592.0 Excludes uric acid nephrolithiasis ( 274.11 ) Applies To Nephrolithiasis NOS Renal calculus or stone Staghorn calculus [icd9data.com]

  Abdomen & Pelvis: Nephrolithiasis - Nonobstructing renal stone (staghorn calculus) Abdomen & Pelvis: Nephrolithiasis - Nonobstructing renal stone (staghorn calculus) < < < Previous page ( ) Next page ( ) > > > < < < Previous chapter ( ) Next chapter [radiologytutorials.com]

  Hidronefrosis. 0 Reply Stag horn kidney stone 0 Reply Emphysematous pylonephritis 0 Reply Staghorn Calculus (Nephrolithiasis) with an isolated Hydronephrosis. [dailyrounds.org]

  Oct 4, 2016 preventive treatment, and practice improvement for nephrolithiasis. [beylikduzuwebtasarim.com]

  It is not uncommon to miss an associated urothelial tumor in a patient of nephrolithiasis preoperatively. [ncbi.nlm.nih.gov]

A low threshold for imaging should be maintained, as prompt referral to urology for stone removal or treatment is necessary. Staghorn calculi have a high likelihood of leading to renal failure or urosepsis without treatment. [westjem.com]

Discussion We feel that the treatment of choice for large staghorn renal calculi remains PCNL. Nonetheless, in select patients consideration must be given to a staged ureteroscopic approach as primary treatment. [hindawi.com]

Treatment options for unilateral staghorn stone Some clinicians, until the 1970s, believed that staghorn stones should be left alone – no active treatment [20]. [ncbi.nlm.nih.gov]

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

The prognosis for renal SCC is extremely poor, and less than 10% of patients survive for 5 years [5, 6]. Whether or not renal calculi cause SCC is unclear. [karger.com]

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]

[…] 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]

Its etiology is associated with urinary tract infection (UTI) caused by bacteria which produce ureases. [scielo.br]

Urease-producing organisms are listed in Etiology. Problem Struvite stones are invariably associated with urinary tract infections. [emedicine.medscape.com]

Allowable Qualifiers English: 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]

Epidemiology of Stone Disease. Urol Clin North Am;34:287–93. (PMID: 22050495) [4] Mishra S, Bhattu AS, Sabnis RB, Desai MR (2014). Staghorn classification: Platform for morphometry assessment. Indian J Urol; 30:80–3. doi:10.4103/0970-1591.124212. [eurorad.org]

Methods: Data from the Informatic Department of Brazilian public health system were obtained as referred to costs in hospital admissions for urinary lithiasis during 2010 and also epidemiological data from 1996 through 2010. [scienceopen.com]

Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-20. DOI: https://doi.org/10.1007/s00345-017-2008-6 Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. [revurologia.sld.cu]

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]

Sections Struvite and Staghorn Calculi Overview Practice Essentials History of the Procedure Problem Epidemiology Etiology Pathophysiology Presentation Indications Relevant Anatomy Contraindications Show All Workup Laboratory Studies Imaging Studies Show [emedicine.medscape.com]

Urease inhibitors Agents that prevent struvite stone formation via supersaturation, also called ‘urease inhibitors’, were first identified in 1960s. [ncbi.nlm.nih.gov]

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].

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.