Clinical findings:
(1) history of a urinary tract procedure or prolonged catheterization in many patients
(2) hematuria
(3) examination of the urinary tract shows calcified plaques adherent to the wall of the bladder, ureter and/or renal pelvis. These may be composed of calcium magnesium phosphate or ammonium magnesium phosphate.
(4) intermittent renal colic on passage of stones or debris
Laboratory findings:
(1) strongly alkaline urine (with release of ammonia)
(2) hematuria and pyuria
(3) struvite crystals (ammonium magnesium phosphate)
(4) urine cultures may be positive or negative depending on the organism
(5) biopsy may show concurrent malakoplakia
Causative bacteria are able to split urea:
(1) Corynebacterium urealyticum (formerly Corynebacterium group D2)
(2) Proteus species
(3) Klebsiella species
(4) Pseudomonas species
(5) Streptococcus species
(6) Staphylococcus species
Corynebacterium may be considered a contaminant and disregarded or require a special medium for growth. It is also highly resistant to many antibiotics.
Complications:
(1) renal failure secondary to obstructive uropathy
(2) pyelonephritis
(3) incontinence
(4) scarring with loss of bladder capacity
(5) anemia
Patients at risk for serious complications:
(1) renal transplant
(2) immunosuppressed
