Gupta, M.

Kiryluk, K.

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1330   Kidney International (2007) 71
nephrology image http://www.kidney-international.org
© 2007 International Society of Nephrology
Kidney International (2007) 71, 1330. doi:10.1038/sj.ki.5002183
White star in the black sea: An unusual stone 
associated with ureteropelvic junction obstruction
K Kiryluk1 and M Gupta2
1Department of Medicine, Division of Nephrology, Columbia University, College of Physicians and Surgeons, New York, New York, USA; and 
2Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
Correspondence: K Kiryluk, Columbia University, College of Physicians and Surgeons, Division of Nephrology, 622 West 168th Street, PH4 Stem, 
Room 124, New York, New York 10032, USA. E-mail: kk473@columbia.edu
An asymptomatic 59-year-old man was referred to our medical 
center for evaluation of an incidental computed tomography 
scan abnormality (Figure 1). Th e patient denied fl ank pain, 
fevers, chills, dysuria, and hematuria. Physical examination was 
unremarkable. On laboratory evaluation, his creatinine level was 
1.2 mg per dl (normal 0.6–1.2 mg per dl), and his blood urea 
nitrogen level was 20 mg per dl (normal 7–20 mg per dl). Other 
electrolytes were within normal limits. Urinalysis revealed a pH 
of 5.0, 2+ blood, and no protein. Urine microscopy showed many 
red blood cells per high power fi eld, but no crystals.
Th e patient underwent ureteroscopy. A 5-French cathe-
ter was successfully passed through the area of the left 
ureteropelvic obstruction. Retrograde pyelogram demon-
strated a massively dilated renal pelvis, upper-pole hydroca-
lyx, and an enormous stellate calculus within the renal pelvis 
(Figure 2). A percutaneous nephrolithotomy with neph-
rostomy tube placement was performed successfully. Th e 
retrieved calculus was sent for analysis, which revealed that 
it was composed primarily (90%) of calcium oxalate monohy-
drate with 10% contribution of calcium phosphate (hydroxy- 
and carbonate apatite). Th e patient was discharged home in 
excellent condition. A postoperative computed tomography 
scan 1 month later revealed complete resolution of hydro-
nephrosis and no residual calculi.
Figure 2 | Intraoperative endoscopic view of the stellate calculus.Figure 1 | Abnormal computed tomography scan. The left renal 
collecting system is massively dilated. An unusual calculus in the shape 
of a star is present within the collecting system.


White star in the black sea: An unusual stone associated with ureteropelvic junction obstruction 

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White star in the black sea: An unusual stone associated with ureteropelvic junction obstruction

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