RENAL RESISTIVE INDEX AS A PREDICTOR OF ACUTE HYDRONEPHROSIS IN PATIENTS WITH RENAL COLIC
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 22
Abstract
BACKGROUND Urolithiasis remains a major health problem worldwide. Patients with renal colic are 33% to 68.3% at risk of acute urinary obstruction (partial or complete) leading to hydroureteronephrosis. Our study was done to determine the sensitivity of the renal resistive index in diagnosing obstructive uropathy taking non-enhanced helical CT as the gold standard. MATERIALS AND METHODS This is an observational study done in Government Kilpauk Medical College Hospital and Government Royapettah Hospital, Chennai from August 2015 - March 2017. During the study period, patients with unilateral loin pain to emergency department were evaluated with bilateral colour Doppler Ultrasound and plain CT KUB reconstructed images. The Renal RI was calculated by subtracting the peak diastolic velocity from the peak. Renal RI > 0.7 was considered diagnostic of obstructive uropathy. Delta RI >0.06 was taken as diagnostic of obstructive uropathy. The efficacy of these tests was determined by calculating specificity, sensitivity, positive predictive value, negative predictive value and accuracy. RESULTS RI was found to be < 0.7 in 96% (48%) of the 200 patients. Ureteric calculus was seen on CT scan in 32 (33.33%) of these patients. In 64 (67.7%) of these 96 patients, ureteric calculus was not seen on CT. The overall sensitivity of RI was 74.80% and specificity was 87.83%. The PPV of RI was 91.34% and NPV was 66.66%. The diagnostic accuracy of the test was 79.5%. Delta RI was found to be > 0.06 in 104 (52%) patients. Calculus was seen on CT scan in 97 (93.26%) of these 104 patients. In the remaining 7 (6.74%) of these, 104 patients’ calculus was not seen on CT. Delta RI was found to be < 0.06 in 96 (48%) of the 200 patients. Calculus was seen on CT in 30 (31.25%). In 66 (68.75%) of these 96 patients, ureteric calculus was not seen on CT. By taking Delta RI value of > 0.06 as a discriminatory level for obstruction, the overall sensitivity of DRI was 76.37% and specificity was 90.41%. The PPV of Delta RI was 93.26% and NPV was 68.75%. The diagnostic accuracy of the test was 81.5%. CONCLUSION Renal RI is less sensitive in diagnosing acute ureteric obstruction, as RI has been shown to be influenced by various factors. If Delta RI is applied, sensitivity and specificity, positive predictive value, negative predictive value and accuracy in diagnosing complete ureteric obstruction will be increased
Authors and Affiliations
Sivasankar Govindaraju, Arulkumar Ettappan
Keywords
Related Articles
- EP ID EP431920
- DOI 10.14260/jemds/2018/603
- Views 67
- Downloads 0
ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSIS OF SALIVARY GLAND LESIONS
BACKGROUND Salivary glands are affected by a variety lesions which may be non-neoplastic such as inflammation (Sialadenitis), cysts or neoplastic which includes both benign and malignant tumours. Except for acute infecti...
ROLE OF MAST CELLS IN LEPROSY- A STUDY OF 62 CASES
BACKGROUND Mast cells have received little attention in leprosy, but evidence linking them with delayed-type hypersensitivity reactions raises the possibility that they may be of some importance in leprosy. MATERIALS AND...
STATUS OF 25-HYDROXYVITAMIN D LEVELS AND SERUM CONCENTRATION OF PROINFLAMMATORY CYTOKINES (IL-6 AND TNF-Α) IN MIDDLE-AGED TRIBAL SUBJECTS OF TRIPURA
BACKGROUND There have been many studies conducted so far on Non-Alcoholic Fatty Liver Disease (NAFLD) with its many aspects including its association with 25-hydroxyvitamin D levels and its rather complex interplay with...
AN OVERVIEW OF ANTI-TUBERCULOSIS TREATMENT (ATT) IN CAT I NEWLY DIAGNOSED CASES OF TUBERCULOSIS IN RNTCP
BACKGROUND Tuberculosis (TB) remains a global public health problem and a major cause of death from a single infectious agent among adults in India and other developing countries. The aim of this study is to characterise...
MACRODACTYLY WITH POLYSYNDACTYLY OF DISTAL PHALANX OF LEFT SECOND TOE – A RARE CASE REPORT AND ITS EMBRYOLOGICAL REVIEW’
Polydactyly is one of the common congenital anomaly. It occurs in many forms, ranging from varying degrees of mere splitting to complete duplication. It belongs to the category of duplication. The extra digit c...