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{
    "pk": 10425,
    "title": "A Comparison of Urolithiasis in the Presence and Absence of Microscopic Hematuria in the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nUrolithiasis is a common medical condition that accounts for a large number of emergency department (ED) visits each year and contributes significantly to annual healthcare costs. Urinalysis is an important screening test for patients presenting with symptoms suspicious for urolithiasis. At present there is a paucity of medical literature examining the characteristics of ureteral stones in patients who have microscopic hematuria on urinalysis versus those who do not. The purpose of this study was to examine mean ureteral stone size and its relationship to the incidence of clinically significant hydronephrosis in patients with and without microscopic hematuria.\nMethods:\n This is a retrospective chart review of patient visits to a single, tertiary academic medical center ED between July 1, 2008, and August 1, 2013, of patients who underwent non-contrast computed tomography of the abdomen and pelvis and urinalysis. For patient visits meeting inclusion criteria, we compared mean stone size and the rate of moderate-to-severe hydronephrosis found on imaging in patients with and without microscopic hematuria on urinalysis.\nResults:\n Out of a total of 2,370 patient visits 393 (16.6%) met inclusion criteria. Of those, 321 (82%) had microscopic hematuria present on urinalysis. Patient visits without microscopic hematuria had a higher rate of moderate-to-severe hydronephrosis (42%), when compared to patients with microscopic hematuria present (25%, p=.005). Mean ureteral stone size among patient visits without microscopic hematuria was 5.7 mm; it was 4.7 mm for those patients with microscopic hematuria (p=.09). For ureteral stones 5 mm or larger, the incidence of moderate-to-severe hydronephrosis was 49%, whereas for ureteral calculi less than 5 mm in size, the incidence of moderate-to-severe hydronephrosis was 14% (p < 0.0001).\nConclusion:\n Patients visiting the ED with single-stone ureterolithiasis without microscopic hematuria on urinalysis could be at increased risk of having moderate-to-severe hydronephrosis compared to similar patients presenting with microscopic hematuria on urinalysis. Although the presence of hematuria on urinalysis is a moderately sensitive screening test for urolithiasis, these results suggest patients without hematuria tend to have more clinically significant ureteral calculi, making their detection more important. Clinicians should maintain a high index of suspicion for urolithiasis, even in the absence of hematuria, since ureteral stones in these patients were found to be associated with a higher incidence of obstructive uropathy.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "urolithiasis, microscopic hematuria, hydronephrosis, emergency medicine"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2hh0132f",
    "frozenauthors": [
        {
            "first_name": "Jason",
            "middle_name": "M.",
            "last_name": "Mefford",
            "name_suffix": "",
            "institution": "University of California, Davis, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Robert",
            "middle_name": "M.",
            "last_name": "Tungate",
            "name_suffix": "",
            "institution": "University of Southern California, Keck School of Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Leila",
            "middle_name": "",
            "last_name": "Amini",
            "name_suffix": "",
            "institution": "University of California, Irvine School of Medicine, Department of Emergency Medicine, Irvine, California",
            "department": "None"
        },
        {
            "first_name": "Dongjin",
            "middle_name": "",
            "last_name": "Suh",
            "name_suffix": "",
            "institution": "Virginia Commonwealth University School of Medicine, Richmond, Virginia",
            "department": "None"
        },
        {
            "first_name": "Craig",
            "middle_name": "L.",
            "last_name": "Anderson",
            "name_suffix": "",
            "institution": "University of California, Irvine School of Medicine, Department of Emergency Medicine, Irvine, California",
            "department": "None"
        },
        {
            "first_name": "Scott",
            "middle_name": "E.",
            "last_name": "Rudkin",
            "name_suffix": "",
            "institution": "University of California, Irvine School of Medicine, Department of Emergency Medicine, Irvine, California",
            "department": "None"
        },
        {
            "first_name": "Megan",
            "middle_name": "",
            "last_name": "Boysen-Osborn",
            "name_suffix": "",
            "institution": "University of California, Irvine School of Medicine, Department of Emergency Medicine, Irvine, California",
            "department": "None"
        }
    ],
    "date_submitted": "2016-10-29T18:32:46Z",
    "date_accepted": "2016-10-29T18:32:46Z",
    "date_published": "2017-05-15T21:03:07Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10425/galley/5732/download/"
        }
    ]
}