9/27/2023 0 Comments Staghorn calculus memeWhile antibiotics alone have been shown to be insufficient in the definitive management of struvite stones, they play a clear role for the safe management of planned directed therapy. 1 Several studies have shown that nonsurgical management of staghorn calculi with antibiotics, urease inhibitors or supportive measures lead to renal deterioration, recurrent urinary-tract infections, sepsis, pain, and increased mortality. The patient was found to have complete dissolution of the right renal stone after 9 months of myriad antibiotic therapies.Īccording to the 2005 AUA guidelines on the management of staghorn calculi, standard of care includes definitive treatment of newly diagnosed otherwise healthy patients with staghorn calculi to render them stone free with intervening procedures. The patient was rendered stone free of renal collecting system stones on the left following the left PCNL, with only a 4 mm and an 8 mm calcification persisting in the renal parenchyma. There are two separate left renal parenchymal calcifications, 4 mm and 8 mm, left mild hydronephrosis, and bilateral parenchymal thinning. 1): A left 3.2 cm renal staghorn involving three calyces with HU of 694 and a right 3.4 cm renal staghorn involving three calyces with HU of 664. Initial CT scan prior to left PCNL ( Fig. International normalized ratio 2.5, sodium 140, potassium 4.4, chloride 104, carbon dioxide 23, blood urea nitrate 53, creatinine 2.2, glomerular filtration rate 31, glucose 85, calcium 8.8, magnesium 1.8, phosphorous 3.2. Laboratory studies: White blood cells count 7.1, hemoglobin 12.7, hematocrit 37.2, platelets 206. The remainder of the examination was unremarkable.ĭiagnostic studies urinalysis: Specific gravity 1.012, pH 7.5, protein 100, nitrite positive, leukocyte esterase positive, red blood cell count >182, white blood cell count 176. PCNL tract on the left showed a well-healed scar. There was no costovertebral tenderness bilaterally. Abdomen was soft with a well-healed midline abdominal incision. Her blood pressure was 167/67 with normal remaining vital signs. As such, her surgery was delayed for 9 months.Įxamination revealed an elderly Caucasian female who was 5.0 feet tall with body mass index of 32.5 kg/m 2. She was scheduled to undergo right PCNL 6 weeks later, but postponed her surgery due to her husband's poor health and ultimate passing. She was discharged from the hospital on postoperative day 3. Stone analysis demonstrated 90% struvite and 10% calcium phosphate, with stone culture positive for Enterococcus faecalis and Proteus mirabilis. A low dose CT scan of the abdomen and pelvis without contrast the following morning revealed resolution of the left collecting system staghorn with persistence of a 4 mm and 8 mm upper and lower pole renal parenchymal calcification, respectively the right staghorn calculus was unchanged. After a 7-day course of levofloxacin, she underwent an upper pole left percutaneous nephrolithotomy (PCNL) with bridging anticoagulation therapy. She underwent an MAG-3 renal Lasix scan, which showed split function of 49.3% on the left and 50.7% on the right, with decreased drainage on the left side (T½ of 22.17 minutes on the left vs 5.33 minutes on the right) with associated left hydronephrosis. Her family history revealed kidney stones in her daughter. Her medications included prophylactic dose cephalexin, lisinopril, furosemide, valsartan, calcium carbonate, acetaminophen with codeine, colace, amiodarone, warfarin, lovastatin, and iron. Her prior surgeries included bilateral hip and knee prostheses and oophorectomy. Her medical history included hypertension, chronic kidney disease, arthritis, atrial fibrillation, hepatitis B, hyperlipidemia, and anemia. Significant in her medical history was a parathyroidectomy 7 years ago for hyperparathyroidism, discovered following metabolic workup for nephrolithiasis serum parathyroid hormone and calcium levels returned to normal. Hounsfield units on the left stone were 694 and on the right stone were 664. Laboratory studies by her physician revealed worsening renal function subsequently, a CT scan showed bilateral >3-cm renal staghorn calculi involving three renal calyces bilaterally with moderate left hydronephrosis. A 77- year-old female was referred due to a history of intermittent left flank pain and recurrent urinary-tract infections.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |