الفهرس | Only 14 pages are availabe for public view |
Abstract Imaging of renal stones is an important diagnostic tool as well as an initial step in deciding the therapeutic option to be used for management. CT of the abdomen and pelvis can be considered as the most accurate diagnostic tool used to evaluate nephrolithiasis patients. Unique radiographic characteristic of increased renal papillary density was found in patients with kidney stones and this radiographic finding supports the role of renal papillary deposits in the pathophysiology of stone formation. More recently a retrospective study demonstrated that increased renal papillary Hounsfield density is associated with an increased future risk of stones. However, the phenomenon of increased renal papillary Hounsfield density in stone formers has not been studied with respect to stone composition. This study aimed to determine the difference in densities of renal papillae in patients with stones compared to control subjects, using attenuation measurements (HU) on Computed Tomography (CT) to determine whether nephrolithiasis is associated with increased density in renal papillae, or not. This prospective case control study was carried out on 124 patients. They were further divided into two groups.Group1 (patient group) included 62 stone formers patients, {34 males (54.8%) and 28 females (45.2%)}. The mean age was 38 years with age range from (24 to 60). group 2 (control group) included 62 age and gender matched control subjects. In this study age distribution of our patients revealed that incidence of kidney stone disease commonly occured between age (30 -40) years old. There was no statistically significant difference regarding the gender in stone forming patients. In our patients the most commonly encountered clinical presentation was loin pain (46.7 %), followed by dysuria (38.7%). The main finding of this study was that there was highly statistically significant difference (P<0.001) between the stone forming patients and control group as regards renal papillae HU density of upper, middle and lower calyces. Also there were highly statistically significant difference (P<0.001) between the non-stone bearing kidney in unilateral kidney stone formers and control group regarding HU of renal papillae of upper, middle and lower calyces. While there were no statistically significant difference (P= 0.35) between kidney with stone and kidney without stone in unilateral kidney stone formers, according to HU of renal papillae of upper, middle and lower calyces. This suggests that changes in the renal papilla which result in elevated Hounsfield density measurements in these patients occur in both kidneys, and not just in the calyx where the calculus has formed. Further large scale studies are necessary to confirm the obtained results. |