Endourology and StonesGas-containing Renal Stones: Findings From Five Consecutive Patients
Section snippets
Material and Methods
After gaining approval from our institutional review board, the records of 5 patients with gas-containing renal calculi treated at our institution from November 2009 to July 2011 were reviewed. Data on demographics, comorbidities, clinical course, surgical intervention, urinary microbiology, stone composition and culture, and metabolic evaluation were extracted and characterized.
Results
All 5 patients were premenopausal women ranging in age from 31 to 47 years (mean 40.4 ± 6.5; Table 1). The mean body mass index was 28.4 ± 8.3 kg/m2. The initial manifestations included flank pain in 4 patients and sepsis in 1. The youngest patient was referred 4 weeks postpartum; her stone had initially been identified during the third trimester of pregnancy. Three subjects had diabetes mellitus, two poorly controlled. Three subjects had hypertension, and one had a history of gout. Two
Comment
Renal stones containing gas are very rare. A total of 9 cases, including the present series, have been reported. The characteristics of the previous cases are listed in Table 2. Most of the patients have been women. This is not unexpected because women are more susceptible to developing urinary tract infections (UTIs). Coexistent medical comorbidities were common, including some associated with stone risk such as diabetes mellitus, gout, hyperparathyroidism, and sarcoidosis. Of the 9 subjects,
Conclusion
Gas-containing renal stones are rare and are likely due to a combination of metabolic and infectious factors. Female patients with diabetes mellitus might be the most susceptible. Proper patient preparation, including both targeted and broad-spectrum antibiotic therapy, initial renal drainage in those with any signs of sepsis, and eventual PCNL, appear to be the steps of successful management.
References (17)
- et al.
Gas-containing renal stones
J Urol
(2006) - et al.
Composition of urinary calculi related to urinary tract infection
J Urol
(1992) - et al.
Clinical implications of abundant calcium phosphate in routinely analyzed kidney stones
Kidney Int
(2004) - et al.
Enhanced H2 gas production from bagasse using adhE inactivated Klebsiella oxytoca HP1 by sequential dark-photo fermentations
Bioresour Technol
(2010) - et al.
Gas-forming infection of the urinary tract: an investigation of fermentation as a mechanism
J Urol
(1990) - et al.
Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection
J Urol
(1991) Recent advances in the pathophysiology of nephrolithiasis
Kidney Int
(2009)- et al.
Emphysematous pyelonephritis
Arch Intern Med
(2000)
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Financial Disclosure: The authors declare that they have no relevant financial interests.