Staghorn calculus symptoms9/10/2023 Cystine stones often start to form in childhood.Ī major risk factor for kidney stones is constant low urine volume. When high amounts of cystine are in the urine, it causes stones to form. It is when the kidneys do not reabsorb cystine from the urine. Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. Cystine stones (less than 1 percent of stones)Ĭystine is an amino acid that is in certain foods it is one of the building blocks of protein. People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders (paralysis, multiple sclerosis, and spina bifida) are at the highest risk for developing these stones. These stones are often large, with branches, and they often grow very fast. Magnesium ammonium phosphate (struvite) stones form in alkaline urine. Some bacteria make the urine less acidic and more basic or alkaline. These stones are related to chronic urinary tract infections (UTIs). Struvite stones are not a common type of stone. Struvite/infection stones (10 percent of stones) A diet that is high in animal protein and low in fruits and vegetables.Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Uric acid is a waste product that comes from chemical changes in the body. Uric acid stones (5-10 percent of stones) Even with normal amounts of calcium in the urine, calcium stones may form for other reasons. Some people have too much calcium in their urine, raising their risk of calcium stones. Calcium oxalate is by far the most common type of calcium stone. There are two types of calcium stones: calcium oxalate and calcium phosphate. If left untreated, staghorn calculi result in chronic infection and eventually may progress to xanthogranulomatous pyelonephritis 5.Diagram of Kidney Stones Enlarge Calcium stones (80 percent of stones)Ĭalcium stones are the most common type of kidney stone. 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. 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 hydrolyses 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, haematuria, flank pain and potentially septicaemia and abscess formation. 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.
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