DefinePK

Abstract

 
Introduction: Obstructive uropathy (OU) comprises a range of urinary system disorders that hinder urine flow, often congenital in nature and significantly contributing to pediatric kidney disease. Timely and precise diagnosis is essential for effective management, with Intravenous Urography (IVU) recognized as the gold standard, though its availability may be limited. In such cases, alternative diagnostic modalities, including abdominal X-ray combined with ultrasonography, are employed, albeit with the limitation that plain radiography offers lower sensitivity for detecting urolithiasis. Comprehensive and efficient management is crucial to minimize the detrimental effects of OU on urinary tract health. This study aims to assist physicians in achieving accurate and early diagnosis of obstructive uropathy, enabling prompt and appropriate treatment to optimize patient prognosis. Objective: This study aims to evaluate the effectiveness of the renal arterial resistive index in diagnosing obstructive uropathy in patients with acute renal colic, using contrast-enhanced helical computed tomography as the gold standard for comparison. Study Design: Descriptive cross-sectional study. Study Duration: From 01/01/2023 to 30/06/2023 Material and methods: After securing ethical approval, a total of 321 patients with unilateral renal colic were enrolled in the study, excluding individuals under 18 years (due to CT-related radiation risks) and over 53 years (owing to potential atherosclerosis-related impacts on Doppler findings). Renal resistive index (RI) was assessed via Doppler ultrasound, with RI values exceeding 0.7 indicative of obstructive uropathy. Subsequently, Contrast-Enhanced CT was employed as the gold standard for comparison with Doppler ultrasound findings. Data collection was conducted using a predesigned questionnaire. Results: A total of 321 individuals participated in the study, with the majority (74.8%) aged between 18 and 40 years. The average age was 36.32 years, with a standard deviation of 9.51. In terms of gender distribution, 55.1% (177) were male, while 44.9% (144) were female. Ureteric calculus was diagnosed in 240 individuals (74.8%), whereas 81 participants (25.2%) showed no signs of the condition. Renal colic was more frequently reported on the left side (55.1%; 177 individuals) compared to the right side (44.9%; 144 individuals). Assessment of obstructive uropathy was conducted using Doppler ultrasound and contrast-enhanced CT, revealing positivity rates of 70.1% and 74.8%, respectively. Doppler ultrasound demonstrated an 80.0% sensitivity and a 59.26% specificity for detecting obstructive uropathy. The positive predictive value was found to be 85.33%, whereas the negative predictive value was 50.00%. Overall, Doppler ultrasound exhibited a diagnostic accuracy of 74.77% when compared to contrast-enhanced CT, underscoring its clinical relevance despite inherent limitations. Conclusion: Doppler ultrasound demonstrates moderate sensitivity and specificity in the diagnosis of obstructive uropathy when compared to contrast-enhanced helical CT. It achieves a positive predictive value of 85.33% and a negative predictive value of 50.00%, resulting in an overall diagnostic accuracy of 74.77%. Despite its clinical utility, the limitations of Doppler ultrasound should be taken into account when interpreting findings.