This is particularly important when the recommended agent is a new and/or infrequently employed drug. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. Usage and distribution for commercial purposes requires written permission. This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Increased fluid intake to achieve a urine output of >2.5 l/day will decrease the risk of urinary supersaturation. Analysis of the composition of the stone and metabolic evaluation are essential for preventing recurrence. The treatment options are medical therapy, surgery, percutaneous nephrolithotomy and shock wave lithotripsy. Therefore, most patients should require treatment of staghorn stones. Over time, staghorn stones cause squamous metaplasia and dysplasia of the uroepithelium. Left untreated, staghorn calculi may cause life-threatening sepsis and renal function impairment. Moreover, the most common component of staghorn calculi in patients in Southern Thailand was uric acid. However, recent data found that 55% of cases with staghorn calculi were from metabolic stones, in particular of calcium phosphate composition. Struvite/calcium carbonate apatite stones are frequently referred to as ‘infection stones' because of the strong relation with urinary tract infection caused by urease-producing Gram-negative bacteria, e.g. Cystine or uric acid mixed with other components can also grow in a staghorn configuration. Staghorn calculi are usually composed of magnesium ammonium phosphate (struvite) and/or calcium carbonate apatite. The final diagnosis was advanced-stage squamous cell carcinoma of the right renal pelvis. There were inferior vena cava invasion and multiple metastases in both hepatic lobes and intra-abdominal lymph nodes. Computed tomography of the chest and abdomen showed an infiltrative tumor with extensive involvement of the right kidney, the right pelvocalyceal system, the right adrenal gland, the right lobe of the liver and the adjacent right hemidiaphragm and psoas muscle (fig. Histopathology was compatible with metastatic squamous cell carcinoma. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed. There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. Thrombosis completely occluded the right leg and partially the left leg. Doppler ultrasound showed acute extensive deep vein thrombosis of both legs along the external iliac vein, the common femoral vein, the proximal deep femoral vein to the popliteal vein. Renal ultrasound visualized large right staghorn calculi and moderate left hydronephrosis with proximal hydroureter (fig.
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