Gross Hematuria: Recurrent Phosphate Staghorn Calculi in a Healthy Adult - A Case Report

Abstract: Staghorn calculi are large renal stones that fill the pelvis of the kidney and pose a significant risk of urosepsis and intrinsic kidney damage. In this case, a 25-year-old healthy female presented with gross hematuria after vigorous cardiovascular exercise for six months. Computed tomography scan demonstrated a 5.4 cm right sided staghorn calculi with hydronephrosis. Right sided percutaneous nephrolithotomy followed by ureteroscopy was performed to remove the stone. On follow up ultrasound 3.5 weeks later, a 16 mm conglomerate of calculi was reformed in the lower calyx, requiring a second ureteroscopy for resolution. Nephrology workup for stone etiology was complicated because the patient did not maintain a stone free period for the gold standard 48 hour urine collection. The case emphasizes a complete workup of gross hematuria, even in healthy young adults and to acknowledge exercise induced hematuria is a diagnosis of exclusion after complete workup for other causes. It highlights the gap in knowledge on staghorn calculi, likely due to the fewer number of cases per year despite the stone free rates for after staghorn calculi surgery being only 42%. There is need for better analysis as the current standard (48 hour urine collection) requires stone free periods that some patients, such as this one, may not be able to maintain and ultimately delay diagnosis and require more surgical procedures and medical risks.