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Becker J, Woźnicki P, Decker JA, Risch F, Wudy R, Kaufmann D, Canalini L, Wollny C, Scheurig-Muenkler C, Kroencke T, Bette S, Schwarz F. Radiomics signature for automatic hydronephrosis detection in unenhanced Low-Dose CT. Eur J Radiol 2024; 179:111677. [PMID: 39178684 DOI: 10.1016/j.ejrad.2024.111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE To investigate the diagnostic performance of an automatic pipeline for detection of hydronephrosis on kidney's parenchyma on unenhanced low-dose CT of the abdomen. METHODS This retrospective study included 95 patients with confirmed unilateral hydronephrosis in an unenhanced low-dose CT of the abdomen. Data were split into training (n = 67) and test (n = 28) cohorts. Both kidneys for each case were included in further analyses, whereas the kidney without hydronephrosis was used as control. Using the training cohort, we developed a pipeline consisting of a deep-learning model for automatic segmentation (a Convolutional Neural Network based on nnU-Net architecture) of the kidney's parenchyma and a radiomics classifier to detect hydronephrosis. The models were assessed using standard classification metrics, such as area under the ROC curve (AUC), sensitivity and specificity, as well as semantic segmentation metrics, including Dice coefficient and Jaccard index. RESULTS Using manual segmentation of the kidney's parenchyma, hydronephrosis can be detected with an AUC of 0.84, a sensitivity of 75% and a specificity of 82%, a PPV of 81% and a NPV of 77%. Automatic kidney segmentation achieved a mean Dice score of 0.87 and 0.91 for the right and left kidney, respectively. Additionally, automatic segmentation achieved an AUC of 0.83, a sensitivity of 86%, specificity of 64%, PPV of 71%, and NPV of 82%. CONCLUSION Our proposed radiomics signature using automatic kidney's parenchyma segmentation allows for accurate hydronephrosis detection on unenhanced low-dose CT scans of the abdomen independently of widened renal pelvis. This method could be used in clinical routine to highlight hydronephrosis to radiologists as well as clinicians, especially in patients with concurrent parapelvic cysts and might reduce time and costs associated with diagnosing hydronephrosis.
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Affiliation(s)
- Judith Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Piotr Woźnicki
- Diagnostic and Interventional Radiology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Franka Risch
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Ramona Wudy
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - David Kaufmann
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Luca Canalini
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Claudia Wollny
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159 Augsburg, Germany.
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Florian Schwarz
- Centre for Diagnostic Imaging and Interventional Therapy, Donau-Isar-Klinikum, Perlasberger Straße 41, 94469 Deggendorf, Germany; Medical Faculty, Ludwig Maximilian University Munich, Bavariaring 19, 80336 Munich, Germany
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Wang M, Zhang J, Zhang B, Ma Q. Value of detected hydronephrosis and hydroureter on ultrasound for detecting a ureteral stone: a retrospective study. Urolithiasis 2023; 51:67. [PMID: 37029823 DOI: 10.1007/s00240-023-01445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
To investigate the predictive value of hydronephrosis and hydroureter in the detection of ureteral stones using ultrasound, a total of 366 patients suffering from ureteral stones confirmed by ultrasound, computed tomography (CT) and their follow-up treatments were consecutively collected. All the included patients underwent systematic ultrasound scanning of the kidney and ureter. The hydronephrosis and hydroureter in each patient were measured using a digital caliper. Then, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values for hydronephrosis and hydroureter to predict a ureteral stone's location and size. The hydronephrosis, hydroureter, and stone size measurements showed good interobserver agreement (P < 0.001). Using the lower border of the sacroiliac joint as a demarcation point, we found larger widths of hydronephrosis and hydroureter in the proximal ureteral stone group than in the distal ureteral stone group (P < 0.001). Additionally, 10.9 mm and 5.9 mm were identified as optimal cutoff values for predicting a distal position (P < 0.001), with no significant difference in their predictive value (P > 0.05). Similar comparisons between groups based on size stratification revealed no significant difference in hydronephrosis between the > 5 mm group and the ≤ 5 mm group. However, the hydroureter was larger in the > 5 mm group than in the ≤ 5 mm group after identifying 6 mm as the best cutoff (P =0.004). In summary, the ultrasound measurement of hydronephrosis and hydroureter may predict the position and size of a possible ureteral stone in patients with colic symptoms.
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Affiliation(s)
- Meng Wang
- Department of Ultrasound, Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Jinfang Zhang
- Caixiang First Village Community Healthcare Service Center, Suzhou, 215004, China
| | - Bo Zhang
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Qi Ma
- Department of Ultrasound, Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
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Ukashi O, Barash Y, Klang E, Zilberman T, Ungar B, Kopylov U, Ben-Horin S, Veisman I. Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection. J Clin Med 2022; 11:jcm11051359. [PMID: 35268450 PMCID: PMC8911438 DOI: 10.3390/jcm11051359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Correspondence: ; Tel.: +972-35-305-000; Fax: +972-35-304-408
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
- DeepVision Lab, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Tal Zilberman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel
| | - Bella Ungar
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52620, Israel; (B.U.); (U.K.); (S.B.-H.); (I.V.)
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo 67011, Israel; (Y.B.); (E.K.); (T.Z.)
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Sert ET, Kokulu K. Relationship between microscopic haematuria and hydronephrosis in urolithiasis. Int J Clin Pract 2021; 75:e14688. [PMID: 34331735 DOI: 10.1111/ijcp.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic haematuria in patients who presented to the emergency department (ED) with ureteral stones. METHODS The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analysed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localisation and degree of hydronephrosis. Patients with and without microscopic haematuria and the degree of hydronephrosis were compared. RESULTS A total of 476 patients were included, which consisted of 391 with microscopic haematuria and 85 without microscopic haematuria. The median stone size was 4.1 mm in the presence of microscopic haematuria and 5.5 mm in the absence of microscopic haematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, P < .001), presence of pyuria (OR: 2.58, 95% CI: 1.78-3.48, P < .001) and absence of microscopic haematuria (OR: 1.31, 95% CI 1.04-2.89, P = .017) were identified as risk factors for moderate and severe hydronephrosis. CONCLUSION We consider that imaging studies may be necessary for the diagnosis, and treatment of emergency cases in which microscopic haematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.
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Affiliation(s)
- Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
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Minotti B, Treglia G, Pascale M, Ceruti S, Cantini L, Anselmi L, Saporito A. Prevalence of microhematuria in renal colic and urolithiasis: a systematic review and meta-analysis. BMC Urol 2020; 20:119. [PMID: 32770985 PMCID: PMC7414650 DOI: 10.1186/s12894-020-00690-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/29/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed urolithiasis at the emergency department. METHODS A comprehensive literature search was conducted to find relevant data on prevalence of microhematuria in patients with suspected acute renal colic and/or confirmed urolithiasis. Data from each study regarding study design, patient characteristics and prevalence of microhematuria were retrieved. A random effect-model was used for the pooled analyses. RESULTS Forty-nine articles including 15'860 patients were selected through the literature search. The pooled microhematuria prevalence was 77% (95%CI: 73-80%) and 84% (95%CI: 80-87%) for suspected acute renal colic and confirmed urolithiasis, respectively. This proportion was much higher when the dipstick was used as diagnostic test (80 and 90% for acute renal colic and urolithiasis, respectively) compared to the microscopic urinalysis (74 and 78% for acute renal colic and urolithiasis, respectively). CONCLUSIONS This meta-analysis revealed a high prevalence of microhematuria in patients with acute renal colic (77%), including those with confirmed urolithiasis (84%). Intending this prevalence as sensitivity, we reached moderate values, which make microhematuria alone a poor diagnostic test for acute renal colic or urolithiasis. Microhematuria could possibly still important to assess the risk in patients with renal colic.
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Affiliation(s)
- Bruno Minotti
- Emergency Department, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
| | - Giorgio Treglia
- Heath Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mariarosa Pascale
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care Medicine, Clinica Luganese, Lugano, Switzerland
| | - Laura Cantini
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luciano Anselmi
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
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Sasmaz Mİ, Kirpat V. The relationship between the severity of pain and stone size, hydronephrosis and laboratory parameters in renal colic attack. Am J Emerg Med 2019; 37:2107-2110. [DOI: 10.1016/j.ajem.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 01/05/2023] Open
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Yao X, Cheng F, Yu W, Rao T, Li W, Zhao S, Zhou X, Ning J. Cathepsin S regulates renal fibrosis in mouse models of mild and severe hydronephrosis. Mol Med Rep 2019; 20:141-150. [PMID: 31115520 PMCID: PMC6580002 DOI: 10.3892/mmr.2019.10230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/02/2019] [Indexed: 12/11/2022] Open
Abstract
As a member of the cysteine protease family, cathepsin S (CTSS) serves an important role in diseases such as cancer, arthritis and atherosclerosis. Nevertheless, its role in renal fibrosis is unknown. In the present study, the effects of CTSS on renal fibrosis in mild (group M) and severe (group S) hydronephrosis were studied by reverse transcription‑-quantitative PCR (RT‑qPCR), western blot analysis (WB), Masson's trichrome staining and immunohistochemical staining in mouse models. The effects of CTSS on extracellular matrix (ECM) deposition and epithelial‑mesenchymal transition (EMT) and the potential mechanisms were further studied by RT‑qPCR and WB in transforming growth factor (TGF‑β1)‑stimulated TCMK‑1 cells. Compared with group N (no hydronephrosis), the expression levels of CTSS in the M and S groups were significantly higher, and a significant increase in ECM deposition was observed in the S group. In addition, compared with group N, the expression levels of TGF‑β1, α‑smooth muscle actin (α‑SMA), SMAD2, SMAD3, phosphorylated (p)SMAD2 and pSMAD3 in groups M and S were significantly higher, whereas the expression of E‑cadherin was significantly lower. Inhibition of CTSS expression increased the expression levels of TGF‑β1, α‑SMA, fibronectin, collagen‑I, SMAD2, SMAD3, pSMAD2 and pSMAD3, whereas E‑cadherin expression decreased. A significant increase in CTSS was observed in the TGF‑β1‑stimulated TCMK‑1 cell line. ECM deposition and EMT were also intensified. The opposite outcomes occurred after intervention with small interfering RNA targeting CTSS. In conclusion, CTSS affected EMT and the deposition of ECM. CTSS may mediate the regulation of fibrosis by the TGF‑β/SMAD signaling pathway. CTSS may serve an important role in the treatment of renal fibrosis.
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Affiliation(s)
- Xiaobing Yao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Weiming Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Wei Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Sheng Zhao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiangjun Zhou
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jinzhuo Ning
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Kim TH, Oh SH, Park KN, Kim HJ, Youn CS, Kim SH, Lim J, Moon HK, Kim HJ. Factors associated with absent microhematuria in symptomatic urinary stone patients. Am J Emerg Med 2018; 36:2187-2191. [PMID: 29622394 DOI: 10.1016/j.ajem.2018.03.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to identify factors associated with absent hematuria in patients with symptomatic urinary stones. METHODS This retrospective study analyzed the clinical and imaging findings of emergency department patients who underwent computed tomography (CT) for suspected ureteral colic over the past 2years. All patients also underwent a microscopic urinalysis, and the presence of 4 or more red blood cells/high-power field was defined as microhematuria. RESULTS A total of 798 patients were included in this study. Of these patients, 750 (94.0%) presented with hematuria, while 48 (6.0%) urine samples did not have evidence of hematuria. The group with an absence of hematuria was more likely to have a lower stone location (located in an area from the distal ureter to the bladder) and perinephric stranding on CT than the hematuria group (75.0% vs. 54.3%, p=0.005; 47.9% vs. 30.5%, p=0.012, respectively). The degree of hematuria at each stone location was significantly different (p=0.001). In multivariate analysis, perinephric stranding (odds ratios (OR) 1.87 [95% confidence interval (CI) 1.01-3.46], p=0.047), a lower stone location (OR 2.72 [95% CI 1.37-5.36], p=0.004), and elevated serum blood urea nitrogen (BUN) levels (OR 1.06 [95% CI 1.01-1.12], p=0.026) were associated with absent hematuria. CONCLUSIONS In this large cohort of patients with renal colic, 6% had no microhematuria. Although some CT findings and elevated BUN were independently associated with hematuria absence, there was no difference in the demographics, time of presentation and degree and location of pain between the groups.
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Affiliation(s)
- Taek Hun Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Kyu Nam Park
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han Joon Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chun Song Youn
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeeyong Lim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyung Ki Moon
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyo Joon Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Mefford JM, Tungate RM, Amini L, Suh D, Anderson CL, Rudkin SE, Boysen-Osborn M. A Comparison of Urolithiasis in the Presence and Absence of Microscopic Hematuria in the Emergency Department. West J Emerg Med 2017; 18:775-779. [PMID: 28611901 PMCID: PMC5468086 DOI: 10.5811/westjem.2017.4.33018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Urolithiasis is a common medical condition that accounts for a large number of emergency department (ED) visits each year and contributes significantly to annual healthcare costs. Urinalysis is an important screening test for patients presenting with symptoms suspicious for urolithiasis. At present there is a paucity of medical literature examining the characteristics of ureteral stones in patients who have microscopic hematuria on urinalysis versus those who do not. The purpose of this study was to examine mean ureteral stone size and its relationship to the incidence of clinically significant hydronephrosis in patients with and without microscopic hematuria. Methods This is a retrospective chart review of patient visits to a single, tertiary academic medical center ED between July 1, 2008, and August 1, 2013, of patients who underwent non-contrast computed tomography of the abdomen and pelvis and urinalysis. For patient visits meeting inclusion criteria, we compared mean stone size and the rate of moderate-to-severe hydronephrosis found on imaging in patients with and without microscopic hematuria on urinalysis. Results Out of a total of 2,370 patient visits 393 (16.6%) met inclusion criteria. Of those, 321 (82%) had microscopic hematuria present on urinalysis. Patient visits without microscopic hematuria had a higher rate of moderate-to-severe hydronephrosis (42%), when compared to patients with microscopic hematuria present (25%, p=.005). Mean ureteral stone size among patient visits without microscopic hematuria was 5.7 mm; it was 4.7 mm for those patients with microscopic hematuria (p=.09). For ureteral stones 5 mm or larger, the incidence of moderate-to-severe hydronephrosis was 49%, whereas for ureteral calculi less than 5 mm in size, the incidence of moderate-to-severe hydronephrosis was 14% (p < 0.0001). Conclusion Patients visiting the ED with single-stone ureterolithiasis without microscopic hematuria on urinalysis could be at increased risk of having moderate-to-severe hydronephrosis compared to similar patients presenting with microscopic hematuria on urinalysis. Although the presence of hematuria on urinalysis is a moderately sensitive screening test for urolithiasis, these results suggest patients without hematuria tend to have more clinically significant ureteral calculi, making their detection more important. Clinicians should maintain a high index of suspicion for urolithiasis, even in the absence of hematuria, since ureteral stones in these patients were found to be associated with a higher incidence of obstructive uropathy.
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Affiliation(s)
- Jason M Mefford
- University of California, Davis, Department of Emergency Medicine, Sacramento, California
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Why we need a higher suspicion index of urolithiasis in children. J Pediatr Urol 2017; 13:164-171. [PMID: 28185760 DOI: 10.1016/j.jpurol.2016.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms. STUDY DESIGN We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures. CONCLUSIONS It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.
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Pyuria and Urine Cultures in Patients with Acute Renal Colic. J Emerg Med 2016; 51:358-364. [DOI: 10.1016/j.jemermed.2015.10.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/24/2015] [Accepted: 10/13/2015] [Indexed: 11/24/2022]
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Ma L, Gao Y, Chen G, Gong J, Yang D, Xie Y, Wang M, Chen H, Song M. Relationships of urinary VEGF/CR and IL-6/CR with glomerular pathological injury in asymptomatic hematuria patients. Med Sci Monit 2015; 21:356-62. [PMID: 25634015 PMCID: PMC4321409 DOI: 10.12659/msm.892085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) have important functions in injury and repair processes of glomerular intrinsic cells. A study was conducted to analyze the urinary VEGF/creatinine (CR) and IL-6/CR levels in simple hematuria patients after excluding the interference of creatinine. We aimed to investigate the function and relationships of the above indices in the glomerular pathological injury process, and to elaborate the values of urinary VEGF and IL-6 changes in the diagnosis of asymptomatic hematuria or hematuria with proteinuria. MATERIAL/METHODS A total of 121 renal hematuria patients diagnosed by clinical and laboratory tests were included as research subjects. The midstream fresh morning urine was collected on the day renal biopsy was performed. RESULTS The IL-6/CR value of the group III was significantly greater than in group I (Z=-2.478, P<0.05), with a statistically significant difference between these 2 groups. The VEGF/CR value of group III was significantly greater than in group II (P<0.01). Compared with group I, the VEGF/CR of group III was significantly greater (Z=-4.65, P<0.01), with a statistically significant difference. CONCLUSIONS The VEGF/CR and IL-6/CR values in simple hematuria patients were positively correlated with glomerular pathological injury scores. VEGF/CR and IL-6/CR might be used as biological diagnostic indicators in determining the extent of simple hematuria glomerular injury.
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Affiliation(s)
- Lu Ma
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Yinghe Gao
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Guanglei Chen
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Junhua Gong
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Dan Yang
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Yongxin Xie
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Mingcui Wang
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Hong Chen
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
| | - Minghui Song
- Integrated Chinese and Western Medicine Treatment of Renal Disease Centre, Beidaihe Sanatorium of Beijing Military Area Command, Chinese PLA, Qinhuangdao, China (mainland)
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