8/31/15 Morning Report – Staghorn Calculi and Proteus Pyelonephritis!

  • Urea splitting organisms include Proteus, Klebsiella, Pseudomonas, and Enterobacter
  • Xanthogranulomatous pyelonephritis can occur in patients with chronic pyelonephritis with recurrent urinary tract infections causing accumulation of granulomatous tissue containing lipid-laden macrophages which can destroy a kidney. Usually this is unilateral and the treatment is nephrectomy. Look for a bear paw on CT!
Kidney Stones Composition PH Visibility on Xray
Calcium Stones (80%)

   

Calcium Oxalate 90%

Calcium Phosphate 10%

Insoluble in Acidic pH (except Ca phosphate) Radiopaque
Struvite (<10%) Magnesium Ammonium Phosphate

Calcium Carbonate Apatite

Insoluble in Alkaline PH Radiopaque (but can be variable)
Uric Acid Stones (~10%) Uric Acid Crystals Insoluble in Acidic pH Radiolucent
Cystine (rare) Cystine (Congenital Cystinuria) Insoluble in Acidic PH Radiolucent

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