The Value of C-reactive Protein Determination in Patients With Renal Colic to Decide Urgent Urinary Diversion
ABSTRACT To analyze whether C-reactive protein (CRP) predicts the need for urgent urinary diversion in patients with renal colic and urolithiasis. CRP may help in the differential diagnosis of complicated hydronephrosis.
Prospective study done on 110 consecutive patients with renal colic secondary to upper urinary tract calculi admitted in the emergency room. Clinical and analytical data were collected. Criteria for emergency drainage had been established in advance, based on the risk of sepsis, renal failure, persistence of pain, and findings on computed tomography scan. CRP was blindly determined using immunoturbidimetric assay on the Integra 700 analyzer. Statistical analysis included Mann-Whitney test, Cox multivariate analysis, and receiver operating characteristic curves, to determine optimum cut-off points to decide drainage based on laboratory data.
Mean CRP value was 47.6 mg/L (CI, 31.4-63.8), 139.6 mg/L (CI, 13-183.1) in 29 patients treated with diversion and 14.67 mg/L (CI, 6.7-22.5) in the control group (P <.001). Age, sex, rate of patients with hypertension, history of cardiovascular disease, leukocyte total count, and serum creatinine differed between groups (P <.05). Regression analysis revealed CRP (P <.0001) and age (P = .0001) were predictive of urinary diversion. Receiver operating characteristic analysis revealed 68.4% area under the curve for creatinine, 68.8% for leukocytosis, and 86.8% for CRP. A cut-off point for CRP of 28 mg/L achieved optimum sensitivity (75.8%) and specificity (88.9%) for determining the decision for drainage.
Determination of CRP in patients with renal colic due to urolithiasis provides an objective and useful parameter for deciding placement of urinary stent, which is even more valuable than leukocytosis or seric creatinine level.
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ABSTRACT: Acute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock. A retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis. Objective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock. APN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.BMC Urology 03/2012; 12:4. DOI:10.1186/1471-2490-12-4 · 1.94 Impact Factor
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ABSTRACT: To assess the effects of atorvastatin (ATORV) on renal function after bilateral ureteral obstruction (BUO), measuring inulin clearance and its effect on renal hemodynamic, filtration, and inflammatory response, as well as the expression of Aquaporin-2 (AQP2) in response to BUO and after the release of BUO. Adult Munich-Wistar male rats were subjected to BUO for 24 hours and monitored during the following 48 hours. Rats were divided into 5 groups: sham operated (n = 6); sham + ATORV (n = 6); BUO (n = 6); BUO + ATORV (10 mg/kg in drinking water started 2 days before BUO [n = 5]; and BUO + ATORV (10 mg/kg in drinking water started on the day of the release of BUO [n = 5]). We measured blood pressure (BP, mm Hg); inulin clearance (glomerular filtration rate [GFR]; mL/min/100 g); and renal blood flow (RBF, mL/min, by transient-time flowmeter). Inflammatory response was evaluated by histologic analysis of the interstitial area. AQP2 expression was evaluated by electrophoresis and immunoblotting. Renal function was preserved by ATORV treatment, even if initiated on the day of obstruction release, as expressed by GFR, measured by inulin clearance. Relative interstitial area was decreased in both BUO + ATORV groups. Urine osmolality was improved in the ATORV-treated groups. AQP2 protein expression decreased in BUO animals and was reverted by ATORV treatment. ATORV administration significantly prevented and restored impairment in GFR and renal vascular resistance. Furthermore, ATORV also improved urinary concentration by reversing the BUO-induced downregulation of AQP2. These findings have significant clinical implication in treating obstructive nephropathy.Urology 04/2012; 80(2):485.e15-20. DOI:10.1016/j.urology.2012.02.021 · 2.13 Impact Factor
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ABSTRACT: Ureteral stones tend to induce inflammatory lesions in the ureteric wall; such lesions may interfere with the probability of spontaneous ureteral stone passage. Plasma C-reactive protein (CRP) is an acute-phase protein whose serum level is increases in response to inflammation, as in ureteric inflammatory disorders induced by stone impaction. Patients with distal ureteric stones were included in this study. All patients were subjected to history taking KUB, urinary tract ultrasound, Non-contrast CT (NC-CTKUB) scan, and plasma CRP estimation. All patients received medical expulsive therapy. Patients were examined weekly using KUB and urinary tract ultrasound until spontaneous stone passage or intervention after 4 weeks. Patients who failed to expel the stone within 4 weeks underwent ureteroscopy. Spontaneous stone expulsion within 4 weeks was recorded in 129 patients (54.9 %), while 106 patients (45.1 %) underwent ureteroscopy for stone extraction. Patients with spontaneous stone expulsion had significantly lower serum CRP levels (16.45 + 2.58) than those who failed to pass the stone spontaneously (39.67 + 6.30). Receiver operator characteristic curve is used to determine CRP cut-off point for prediction of spontaneous ureteric stone expulsion. A cut-off point of 21.9 mg/L for CRP yielded appeared optimal for prediction of spontaneous ureteric stone expulsion. Medical expulsive therapy success for management of small distal ureteric calculi could be predicted with plasma CRP. Patients with CRP >21.9 mg/L have low stone expulsion rate and should directly be subjected for an immediate, minimally invasive ureteroscopy.03/2013; 41(3). DOI:10.1007/s00240-013-0551-1