Update in Diagnosis and Management
Finally, struvite stones require a unique set of urinary conditions to grow: a high urinary pH and high levels of ammonium. This occurs only when the urine is infected with a urease producing organism such as a proteus species.
Therefore, treatment starts with identification and treatment of the infection. The stones are colonized and usually cannot be sterilized with antibiotics alone. Therefore, all stones must be surgically removed. Quite often, these patients have an underlying stone disorder, and a preexisting calcium stone that became colonized with the urease positive organism that in turn led to overgrowth with struvite. Therefore, these patients should undergo metabolic workup for stone risk factors once the infected stone is removed. They often need suppressive antibiotics for 3-6 months postoperatively, with longer term follow-up to be sure they are clear of infection.
Jump to section:
- Kidney Stones
- Why do Kidney Stones Form?
- Genetics and Environment
- Not All Stones are Created Equal: Stone Analysis is Very Helpful
- Laboratory Evaluation
- Supersaturation Index
- Components of the Urinary Supersaturation Profile
- Uses of Urinary Supersaturation
- Common Features Increase Urinary Supersaturation in Patients with Idiopathic Calcium Oxalate Nephrolithiasis
- "Conservative" Dietary Recommendations for Calcium Oxalate Stone Formers
- Causes of Hypercalciuria
- Genetic Hypercalciuria
- Genetic Hypercalciuria: Treatment
- What is Oxalate?
- Hyperoxaluria: What is the Relevant Concentration?
- Oxalate Balance on a Typical Western Diet
- Enteric Hyperoxaluria is Caused by Fat Malabsorption
- Control of Urinary Citrate: Largely Due to Systemic Acid Base Balance
- Treatments for Enteric Hyperoxaluria
- Low Urinary Citrate
- Hyperuricosuria is a Risk Factor for Calcium Oxalate Stones
- Uric Acid is Very Insoluble at Low pH
- Calcium Phosphate is Very Insoluble at High pH!
- Cystine Stones
- Struvite Stones