Abstract
Objective: The Hounsfield unit (HU) is the most common value to assess the stone formation and a predictive factor for the management success. In this study, it was aimed to investigate the prediction of the hardness of the stone using systemic inflammatory response markers.Methods: 192 patients (61 female and 131 male) patients who underwent conventional percutaneous nephrolithotomy (PCNL) between 2015 and 2020 were reviewed retrospectively. Patients with malignancy and history of preoperative urinary tract infection were excluded from this study. Patients’ neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and HU of the kidney Stone, which was obtained from NCCT, were recorded to data.Results: The mean age was 47.2 ± 14.11 (11-82) years. The average HU value of the patients’ stones was 1135.47 ± 362.19 (348-2096). The location of the stones was grouped as pelvis (n:64, 33.3%), single calyx (n:14, 7.2%), two calyces (n:93, 48.4%) and staghorn (n:21, 10.9%). In subgroup analysis, when divided by stone location, a negative correlation was found between the HU and N/L ratio in the single calyceal stone group, and a positive correlation was found between the HU and N/L ratio for pelvis and staghorn stones. Among these correlations, only the positive correlation between the HU and N/L ratio in the pelvic stone group was statistically significant (r=0.318, p=0.03). Assuming an arbitrary cut-off value for HU below 1000, there was no significant correlation between NLR and HU (r=0.266, p=0.171). However, HU above 1000, there was a significant positive correlation between NLR and HU (r=0.145, p=0.045).Conclusion: The findings suggest that NLR could be used as a biomarker to choose appropriate management and be helpful to anticipate the hardness of kidney stones by predicting the HU value.
Highlights
Kidney stones are among the most common urological diseases, with an incidence of 5% to 10% [1]
Patients’ neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and Hounsfield unit (HU) of the kidney Stone, which was obtained from non-contrast computed tomography (NCCT), were recorded to data
In subgroup analysis, when divided by stone location, a negative correlation was found between the HU and N/L ratio in the single calyceal stone group, and a positive correlation was found between the HU and N/L ratio for pelvis and staghorn stones
Summary
Kidney stones are among the most common urological diseases, with an incidence of 5% to 10% [1]. The ideal treatment of renal stone must achieve stone-free status with lower morbidities [2]. The success of treatments depends on operation type, operation time, the number of sessions, stone size and stone composition [3]. The stones which are containing calcium are the hardest to fragment, and the Hounsfield unit (HU) value of stones obtained from non-contrast computed tomography (NCCT) can predict stone hardness and composition [4,5]. The average HU was useful for predicting stone composition, but peak HU was not found convincing. Some molecular markers have been investigated in urine and serum, an ideal feature to aid treatment selection has not been found [6]
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