This is a left renal squamous cell carcinoma arising from a staghorn calculus in a man in his 50s (fig 1). bmj;379/oct26_7/e071630/F1F1f1Fig 1He presented with severe left sided abdominal pain, fever, and left renal angle tenderness. He was anaemic (haemoglobin 66 g/L) with a raised white cell count of 34.37×109 and had acute kidney injury with a glomerular filtration rate of 10 mL/min/1.73 m2. He required continuous inotropic support before emergency left open simple nephrectomy. Histopathology revealed invasive squamous cell carcinoma of the left kidney. The patient had previously declined intervention after incidental discovery of the calculus and failed to attend for follow-up. In addition to the risk of infection, sepsis, and renal failure, untreated chronic staghorn calculus can lead to renal squamous cell carcinoma.

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