Abstract
Objectives: The aim of this study was to determine whether unenhanced computed tomography (CT) imaging can estimate differential renal function (DRF) in patients with chronic unilateral obstructive upper urinary tract stones.Materials and Methods: This was a single-center retrospective study of 76 patients. All the patients underwent unenhanced CT and nuclear renography (RG) at an interval of 4 to 6 weeks due to chronic unilateral obstructive urinary stones. Renal CT measurements (RCMs), including residual parenchymal volume (RPV) and volumetric CT texture analysis parameters, were obtained through a semiautomatic method. Percent RCMs were calculated and compared with renal function determined by RG.Results: The strongest Pearson coefficient between percent RCM and DRF was reflected by RPV (r = 0.957, P < 0.001). Combinations of RPV and other parameters did not significantly improve the correlation compared with RPV alone (r = 0.957 vs. r = 0.957, 0.957, 0.887, 0.815, and 0.956 for combination with Hounsfield unit, parenchymal voxel, skewness, kurtosis, and entropy, respectively; all P < 0.001). Percent RPV was subsequently introduced into linear regression, and the equation y = −2.66 + 1.07* × (P < 0.001) was derived to calculate predicted DRF. No statistically difference was found between predicted DRF using the equation and observed DRF according to RG (P = 0.959).Conclusion: Unenhanced CT imaging can estimate DRF in patients with chronic unilateral obstructive upper urinary tract stones, and RG might not be necessary as a conventional method in clinical.
Highlights
Urolithiasis is the most common disease that encountered in urology departments, and affects 1–20% of the adult population
renal CT measurements (RCM) were automatically calculated based on MATERIALS AND METHODS. This retrospective study was conducted under the approval of the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (2019S1035) and the informed consent was waived
Ureteroscopic lithotripsy was performed in 16 cases, and percutaneous nephrolithotomy was performed in 33 cases, the remaining 27 patients underwent laparoscopic nephrectomy
Summary
Urolithiasis is the most common disease that encountered in urology departments, and affects 1–20% of the adult population. In developed countries, such as Canada, Sweden and the United States, the prevalence of urolithiasis is greater than 10% [1]. Owing to the lack of periodic physical examination, a large number of patients experience acute or chronic obstruction and renal failure. Estimation of differential renal function (DRF), which reflects the contribution of a single kidney to overall renal function, of the obstructed kidney is vital to decide whether it is worth saving. A cut-off value of 15% split DRF is commonly used by urologists when counseling patients to undergo lithotripsy vs nephrectomy [3]
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