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MCQ – 71138

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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. What can be the most possible diagnosis?
A. Renal Infarct
B.

Renal Calculus
C.

Ureteric Calculus
D.

Renal Carcinoma
Show Answer

Correct Answer � B

Explanation

Ans: B.)Renal Calculus

Image shows: Coned KUB shows radioopacities (arrows) over the left renal area which may represent renal stones.

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

    • (1) Suspected urinary tract calculus

    • (2) Radio-lucent calculus which is not visualized on KUB

    • (3) Ureteric calculus may not be demonstrated by ultrasound.

  • Information on IVU which is helpful in the management of patients with renal stone include:

    • 1. Size of renal stones.

    •  2. Coexisting ureteric obstruction – extracorporeal shock wave lithotripsy (ESWL) may not be possible since stone fragments cannot pass down the ureter.

    • 3. Associated renal cortical scarring.

  • If a patient is allergic to an intravenous contrast medium, ultrasound is a good alternative imaging modality for diagnosis.

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