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Struvite NephrolithiasisAka: Struvite Stone, Struvite Calculi, Infection Stone, Triple-Phosphate Stone

See Also
1. Nephrolithiasis
Epidemiology
1. More common in women
Pathophysiology
1. Most common cause of staghorn calculi
2. Components
  1. Magnesium
  2. Ammonium
  3. Calcium Phosphate
Risk Factors
1. Neurogenic bladder
2. Urinary tract foreign body
3. Urinary Tract Infection with urea-splitting bacteria
  1. Infection alkalinizes urine
  2. Increases ammonium concentration
  3. Bacterial causes
    1. Proteus mirabilis
    2. Ureaplasma urealyticum
    3. Klebsiella Pneumonia
Imaging
1. Faintly radiopaque
Complications
1. Infection (common)
Management
1. Start antibiotics
  1. High risk of overwhelming Sepsis
2. Urgent urology consultation
  1. Surgery delayed until afebrile for 48 hours
3. Consider acetohydroxamic acid (Lithostat)
  1. Irreversible urease inhibitor
    1. Prevents struvite crystallization
  2. Risk of Deep Vein Thrombosis
  3. Indications
    1. Calculus-related severe infections
    2. Patients who are not surgical candidates
References
1. Pietrow (2006) Am Fam Physician 74:86

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.