The Role of Retrograde Pyelography for Evaluation of Hematuria in Patients with Normal and Impaired Renal Function

Abstract

Purpose. Hematuria can be a sign of urinary tract disorders; therefore, it is necessary to arrange complete imaging studies to evaluate the entire urinary system. Our purpose is to elucidate the efficacy of retrograde pyelography (RP) for evaluating patients who present with hematuria. Methods. From 2000 to 2002, a total of 634 patients underwent RP procedures because of hematuria. After excluding the 378 patients with urothelial carcinoma, stone disease, and urinary tract infection, 256 patients were included in this study. Patients were divided into two groups based on renal function: Group I: normal renal function (n=156); Group Ⅱ: poor renal function (Cr＞2.0) (n=100). Patients in Group Ⅰ were further classified into either group Ⅰa: gross hematuria (n=104) or Ⅰb: microscopic hematuria (n=52). Patients in Group II were further subdivided into either Group Ⅱa uremia (n=39) or Ⅱb: chronic renal function impairment (n=61). Results. Patients in Group Ⅱ(50.0%) were more likely to have malignancy (OR=4.2, 95% CI=2.5 to 7.0, p＜0.001) than those in Group Ⅰ(19.2%). In Group Ⅱ, uremia (74.3%) was most closely associated with urothelial carcinoma (OR=5.5, 95% CI=2.3 to 13.1, p＜0.05). The rate of stone disease was significantly higher for Group Ⅱ(OR=2.0, 95% CI=1.1 to 3.8, p＜0.005). Conclusions. Patients with impaired renal function are more likely to have urinary stone disease and urothelial cancer than those with normal renal function. Thus, RP is more valuable for evaluating hematuria in patients with impaired renal function than in those with normal renal function. Among the patients with impaired renal function, uremic patients are at highest risk of having urothelial cancer in Taiwan. Therefore, it is crucial to perform RP and cystoscopy for patients with impaired renal function, especially for those with uremia.