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Spontaneous complete resolution of renal staghorn stone in 11-year-old child with severe burns
Journal of Pediatric Urology (2006) 2, 214
LETTER TO THE EDITOR Spontaneous complete resolution of renal staghorn stone in 11-year-old child with severe burns We describe for the first time a case of spontaneous resolution of complete staghorn calculi in an 11-year-old child admitted to hospital due to 48% 4th and 3rd degree burns. The patient was bedridden for a long time, and developed recurrent UTIs. Evaluation demonstrated a full renal staghorn stone. Complete metabolic evaluation did not reveal any pronounced abnormality. Percutaneous nephrolothotripsy (PCNL) could not be performed due to the patient’s general condition; a left percutaneous nephrostomy was set up and tentative plans made for surgery. However, as the child recovered from the acute condition and became more mobile, he reported daily expulsion of urinary stones. Repeated imaging including spiral CT demonstrated a constant decrease of the stone until clearance of all fragments. The etiology of this patient’s condition was probably a combination of processes related to his critical condition including: metabolic acidosis, relative dehydration, prolonged immobilization and bone resorption [1], and recurrent UTIs [2]. Complete [2] spontaneous resolution probably occurred due to reversal of the stone-promoting processes, i.e. normalization of the acidebase balance, restored urine volume and concentration, mobilization, proper alimentation, proper kidney drainage, and antibiotics [3]. Spontaneous resolution of complete staghorn calculi has not been described previously; however, it should be emphasized that the management of this child was planned according to the guidelines and he was scheduled for PCNL. In summary, we describe a unique case of an 11year-old child with severe burns in whom metabolic and physical factors combined together to produce renal staghorn calculi. His recovery from the acute illness reversed the same factors causing spontaneous disintegration of the stone, due probably to the fact that children have a greater ability
to expel stones spontaneously [4]. The fortunate outcome of this case should not change our attitude towards the management of staghorn calculi. Physicians should be aware of urological complications in patients with severe burns, and take preventive measures to avoid them.
References [1] Jeantet A, Giachino G, Rossi P, Tetta C, Thea A, Squiccimarro G, et al. Immobilization: a cause of resorptive hypercalciuria. Contrib Nephrol 1984;37:31e5. [2] Akagashi K, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, et al. Characteristics of patients with staghorn calculi in our experience. Int J Urol 2004;11:276e81. [3] Bachelder VD, Muehlstedt SG, Smith CL. Hyperphosphatemia in a burn patient. J Burn Care Rehabil 2001;22:187e9. [4] Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, et al. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm? J Urol 2001:1862e4.
Sarel Halachmi* Shimon Meretyk Department of Urology, Rambam Medical Center, Faculty of Medicine, Technion e Israeli Institute of Technology, POB 9602, Haifa 31096, Israel Giora Pillar Doua Bachri Naim Shehadeh Department of Pediatrics A, Rambam Medical Center, Faculty of Medicine, Technion e Israeli Institute of Technology, POB 9602, Haifa 31096, Israel *Corresponding author. Tel.: C972 4 8542693; fax: C972 4 8542745. E-mail address: [email protected] 20 July 2005 Available online 13 September 2005
1477-5131/$30 ª 2005 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2005.07.009
LETTER TO THE EDITOR Spontaneous complete resolution of renal staghorn stone in 11-year-old child with severe burns We describe for the first time a case of spontaneous resolution of complete staghorn calculi in an 11-year-old child admitted to hospital due to 48% 4th and 3rd degree burns. The patient was bedridden for a long time, and developed recurrent UTIs. Evaluation demonstrated a full renal staghorn stone. Complete metabolic evaluation did not reveal any pronounced abnormality. Percutaneous nephrolothotripsy (PCNL) could not be performed due to the patient’s general condition; a left percutaneous nephrostomy was set up and tentative plans made for surgery. However, as the child recovered from the acute condition and became more mobile, he reported daily expulsion of urinary stones. Repeated imaging including spiral CT demonstrated a constant decrease of the stone until clearance of all fragments. The etiology of this patient’s condition was probably a combination of processes related to his critical condition including: metabolic acidosis, relative dehydration, prolonged immobilization and bone resorption [1], and recurrent UTIs [2]. Complete [2] spontaneous resolution probably occurred due to reversal of the stone-promoting processes, i.e. normalization of the acidebase balance, restored urine volume and concentration, mobilization, proper alimentation, proper kidney drainage, and antibiotics [3]. Spontaneous resolution of complete staghorn calculi has not been described previously; however, it should be emphasized that the management of this child was planned according to the guidelines and he was scheduled for PCNL. In summary, we describe a unique case of an 11year-old child with severe burns in whom metabolic and physical factors combined together to produce renal staghorn calculi. His recovery from the acute illness reversed the same factors causing spontaneous disintegration of the stone, due probably to the fact that children have a greater ability
to expel stones spontaneously [4]. The fortunate outcome of this case should not change our attitude towards the management of staghorn calculi. Physicians should be aware of urological complications in patients with severe burns, and take preventive measures to avoid them.
References [1] Jeantet A, Giachino G, Rossi P, Tetta C, Thea A, Squiccimarro G, et al. Immobilization: a cause of resorptive hypercalciuria. Contrib Nephrol 1984;37:31e5. [2] Akagashi K, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, et al. Characteristics of patients with staghorn calculi in our experience. Int J Urol 2004;11:276e81. [3] Bachelder VD, Muehlstedt SG, Smith CL. Hyperphosphatemia in a burn patient. J Burn Care Rehabil 2001;22:187e9. [4] Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, et al. Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm? J Urol 2001:1862e4.
Sarel Halachmi* Shimon Meretyk Department of Urology, Rambam Medical Center, Faculty of Medicine, Technion e Israeli Institute of Technology, POB 9602, Haifa 31096, Israel Giora Pillar Doua Bachri Naim Shehadeh Department of Pediatrics A, Rambam Medical Center, Faculty of Medicine, Technion e Israeli Institute of Technology, POB 9602, Haifa 31096, Israel *Corresponding author. Tel.: C972 4 8542693; fax: C972 4 8542745. E-mail address: [email protected] 20 July 2005 Available online 13 September 2005
1477-5131/$30 ª 2005 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2005.07.009