Question
A 52-year-old woman presented with gross haematuria associated with right loin pain for 3 days. On physical examination, she was tender over the right loin region but was afebrile.
Blood tests were essentially normal. A KUB was performed as an initial investigation followed by an IVU a few days later .What can be the most possible diagnosis?
A. Renal Infarct
B. Renal Calculus
C. Ureteric Calculus
D. Renal Carcinoma
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Correct Answer » B Explanation |
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Ans:B. Renal Calculus
Image shows:
- Fig.a. Coned KUB shows radioopacities (arrows) over the left renal area which may represent renal stones.
- Fig.b A tomogram obtained during an IVU shows filling defects (arrows) in the left upper pole calyx and left renal pelvis corresponding to the opacities seen on the KUB.
- This supports the diagnosis of left renal calculi. Note that the stones appear radiolucent against a background of contrast. Also note the clubbing of the adjacent minor renal calyces (arrowheads).
RENAL CALCULUS
- Renal calculus is a common cause of haematuria, particularly in the presence of loin pain.
- Renal calculi are composed of crystals and/or aggregated with proteins.
- The crystal may contain calcium or magnesium oxalate/phosphate (which are radio-opaque and found in the majority of stones) or uric acid/ xanthine (which are not radio-opaque). As a result of this variable composition, the majority (~90%) of renal stones are radio-opaque, hence a KUB is useful as the initial investigation in a patient with suspected urinary calculus.
IVU is the key imaging modality for the diagnosis of
- Suspected urinary tract calculus
- Radio-lucent calculus which is not visualized on KUB
- Ureteric calculus which may not be demonstrated by ultrasound.
Information on IVU which is helpful in management of patients with renal stone include:
- Size of renal stones – stones
- Coexisting ureteric obstruction – extracorporeal shock wave lithotripsy (ESWL) may not be possible since stone fragments cannot pass down the ureter
- Associated renal cortical scarring.
- If a patient is allergic to intravenous contrast medium, ultrasound is a good alternative imaging modality for diagnosis