Rud Oleg, Horstmann Marcus, Aziz Atiqullah, Fritsche Hans-Martin, Brookman-May Sabine, Gilfrich Christian, Burger Maximilian, May Matthias
Department of Urology, St. Elisabeth-Hospital Straubing, Straubing, Germany,
World J Urol. 2014 Jun;32(3):691-5. doi: 10.1007/s00345-013-1119-y. Epub 2013 Jun 23.
The aim of our prospective designed study was to confirm the intra-observer agreement of assessments of the hydronephrosis index (HI) with a sonographic technique that potentially provides additional information in patients with acute renal colic (ARC).
Sonographic measurement of HI and valuation of common clinical criteria were performed in 44 consecutive patients presenting with unilateral stone-related ARC. HI of colic side was recorded twice in predefined time intervals. Intra-observer agreement was evaluated with the Spearman's rank correlation/rho (ρ) for attributive-metric characteristics. Data of HI-measurement on the colic side were compared with data of the unaffected side using t test.
Intra-observer agreement was significant for HI in the colic side (ρ = 0.918, p < 0.001) and in the unaffected side (ρ = 0.826, p < 0.001). The mean HI between colic and unaffected side differed significantly on the first evaluation (85.2 vs. 93.7, respectively; p < 0.001) and on the second evaluation (85.1 vs. 93.6, respectively; p < 0.001) as well.
The HI method is a slightly feasible examination method in patients presenting with stone-related renal colic. Moreover, it offers a solid discrimination between obstruction and non-obstruction. Our prospective trial illustrates HI as a reproducible method with a high-grade intra-observer agreement. However, potential change of values under medical expulsive therapy and coherency with the functionality of the obstructed kidney may lead to bias and therefore remain to be analyzed. Further studies to specify exact thresholds for this method and to state our findings are required.
我们这项前瞻性设计研究的目的是，通过一种超声技术来确认肾积水指数（HI）评估的观察者内一致性，该技术可能为急性肾绞痛（ARC）患者提供额外信息。
对44例连续出现单侧结石相关性急性肾绞痛的患者进行了HI的超声测量和常见临床标准的评估。在预先定义的时间间隔内，对绞痛侧的HI进行了两次记录。采用Spearman等级相关性/ρ（ρ）评估观察者内一致性的属性计量特征。使用t检验比较绞痛侧HI测量数据与未受影响侧的数据。
观察者内一致性在绞痛侧HI方面具有显著性（ρ = 0.918，p < 0.001），在未受影响侧HI方面也具有显著性（ρ = 0.826，p < 0.001）。在第一次评估时，绞痛侧与未受影响侧的平均HI存在显著差异（分别为85.2和93.7；p < 0.001），在第二次评估时同样存在显著差异（分别为85.1和93.6；p < 0.001）。
HI方法在出现结石相关性肾绞痛的患者中是一种稍有可行性的检查方法。此外，它能很好地区分梗阻与非梗阻情况。我们的前瞻性试验表明HI是一种具有高度观察者内一致性的可重复方法。然而，药物排石治疗下数值的潜在变化以及与梗阻肾脏功能的一致性可能导致偏差，因此仍有待分析。需要进一步研究来明确该方法的确切阈值并阐述我们的研究结果。
