A.A., a 48-year-old woman, was admitted to the in-patient unit from the ER with severe right flank pain unresponsive to analgesics. Her pain did not decrease with administration of 100 mg of IV meperidine. She had a 3-month history of chronic UTI. Six months ago she had been prescribed calcium supplements for low bone density. Her gynecologist warned her that calcium could be a problem for people who are "stone-formers." A.A. was unaware that she might be at risk. An IV urogram showed a right staghorn calculus. The diagnosis was further confirmed by a renal ultrasound. A renal flow scan showed normal perfusion and no obstruction. Kidney function was 37% on the right and 63% on the left. While the pain became intermittent, A.A. had no hematuria, dysuria, frequency, urgency, or nocturia. Urianalysis revealed no albumin, glucose, bacteria, or blood; there was evidence of cells, crystals, and casts.

A.A. was transferred to surgery for a cystoscopic ureteral laser lithotripsy, insertion of a right retrograde ureteral catheter, and right percutaneous nephrolithotomy. A ureteral calculus was fragmented with the pulsed-dye laser. Most of the stag horn was removed from the renal pelvis with no remaining stone in the renal calices. She was discharged 2 days later and ordered to strain her urine for the next week for evidence of stones.

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