Acute Flank Pain in Dialysed Patients. Demonstration of Hydroneperosis by Computer Tonography

Abstract

Repeated episodes of acute renal flank pain were observed in a uremic patient on maintenance hemodialysis. Computer tomography during the acute attack repeatedly showed unilateral hydronephrosis which always subsided after passage of stones. X-ray failed to visualize the non-radioopaque stones and sonography was non-contributory. The stones consisted of organic matrix and contained protein material. The present observation documents that computer tomography is valuable in establishing the diagnosis of acute ureteral obstruction resulting from non-radioopaque renal stones in dialysed patients with contracted kidneys.

Evidence against a contribution of conventional urine risk factors to de novo ESRD renal stones

“…The role of matrix may be important, and was not considered here Some believe that the organic matrix component plays a major role in ESRD stone formation [19]. Protein stones may be difficult to detect by radiographic methods and they may present as recurrent episodes of hydronephrosis [24]. Various protein structures have been detected in HD stone formers, microfibrillary [5,24], amyloidal [14] among them.…”

“…Protein stones may be difficult to detect by radiographic methods and they may present as recurrent episodes of hydronephrosis [24]. Various protein structures have been detected in HD stone formers, microfibrillary [5,24], amyloidal [14] among them. Japanese investigators [15] compared protein composition of these stones to the protein matrix composition of CaOx stones in non-dialysis patients and found the structural patterns to be different: in chronic HD patients (b2 microglobulin>lysozyme>albumin, serum amyloid P component (SAP), Tamm-Horsfall protein (THP) vs non-dialysis patients (albumin>lysozyme>SAP, THP).…”

Ureteric Pain in Patients with Chronic Renal Failure on Hemodialysis

“…Caralps et al [3] reported that the incidence of excretion of renal calculi in patients on hemodialysis was 7.5% and Bommer et al [2] reported that the incidence of renal matrix stone formation was about 5%. Ono and Emoto [7] reported ureteric colic with urinary excretion of stone-like particles in 9 out of 40 cases on chronic hemodialysis (22.5%).…”

“…[2] recently reported a single case of hydro nephrosis resulting from a nonradiopaque renal stone in a dialyzed patients with contracted kidney who had acute flank pain. This was demonstrated by computer tomogra phy, but not by ultrasonography.…”

“…Patients with chronic renal failure who are maintained on hemodialysis occasionally complain of flank, lumbar or lower abdominal pain and excrete stones or stone-like particles [1][2][3]7], Ono andEmoto [7] demonstrated ureteral stones by retrograde pyelography in these patients, and Bommer et al [2] demonstrated hydronephrosis due to de novo renal matrix stone by computer tomography in a single case.…”