Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey.
Int J Clin Pract. 2021 Oct;75(10):e14688. doi: 10.1111/ijcp.14688. Epub 2021 Aug 6.
The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic haematuria in patients who presented to the emergency department (ED) with ureteral stones.
The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analysed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localisation and degree of hydronephrosis. Patients with and without microscopic haematuria and the degree of hydronephrosis were compared.
A total of 476 patients were included, which consisted of 391 with microscopic haematuria and 85 without microscopic haematuria. The median stone size was 4.1 mm in the presence of microscopic haematuria and 5.5 mm in the absence of microscopic haematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, P < .001), presence of pyuria (OR: 2.58, 95% CI: 1.78-3.48, P < .001) and absence of microscopic haematuria (OR: 1.31, 95% CI 1.04-2.89, P = .017) were identified as risk factors for moderate and severe hydronephrosis.
We consider that imaging studies may be necessary for the diagnosis, and treatment of emergency cases in which microscopic haematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.
本研究旨在探讨在因输尿管结石就诊于急诊科的患者中，肾积水程度与镜下血尿之间的关系。
回顾性分析了 2017 年 1 月至 2020 年 12 月期间因尿路结石就诊于我院急诊科的患者的病历。本研究纳入了接受腹部/骨盆非增强 CT 及尿分析（UA）检查并诊断为输尿管结石且年龄≥18 岁的患者。回顾放射学报告以评估结石大小、定位和肾积水程度。比较有镜下血尿和无镜下血尿的患者及肾积水程度。
共纳入 476 例患者，其中 391 例有镜下血尿，85 例无镜下血尿。有镜下血尿患者的结石中位大小为 4.1mm，无镜下血尿患者的结石中位大小为 5.5mm。采用 logistic 回归分析确定与肾积水发展相关的因素。结石大小[比值比（OR）：2.15，95%置信区间（CI）：1.12-4.16，P<0.001]、脓尿存在（OR：2.58，95%CI：1.78-3.48，P<0.001）和无镜下血尿（OR：1.31，95%CI：1.04-2.89，P=0.017）被确定为中重度肾积水的危险因素。
我们认为，对于未在尿分析中发现镜下血尿的急诊病例，影像学检查可能有助于诊断和治疗，因为这些患者的结石可能更大，肾积水程度可能更严重。
