Non-infectious causes of recurrent flank pain in older children

To find out the etiology of non-infectious recurrent flank pain in older children. The medical records of 84 consecutive children older than 5 years of age with non-infectious flank pain were retrospectively reviewed. Data checked included history, physical examination, laboratory investigations [serum creatinine, uric acid, and calcium], 24 hour urine collection for creatinine, calcium, oxalate, and uric acid, in addition to imaging studies. Those with systemic disease and urinary tract infection [UTI] were excluded. The most common causes of recurrent non-infectious flank pain in older children were crystalluria [59.5%] and urolithiasis [17.8%]. Amongst the crystalluria, hyperoxaluria was the most frequent. Other etiologies included constipation [6.0%], sterile vesicoureteral reflux [6.0%], and pelviureteric junction obstruction [4.7%].Family history was positive for stones in 45% of urolithiasis cases.Renal ultrasonography was adequate for diagnosing all kidney stonesand unenhanced helical computed axial tomography [UHCT] diagnosed ureteral stones with typical renal colic pain radiating to the groin. Constipation was found to be an important, yet overlooked cause of extraurinary flank pain. The most important non-infectious causes of recurrent flank pain in older children were crystalluria, urolithiasis, constipation, pelviureteric junction obstruction, and sterile vesicoureteral reflux. A positive family history of stones played a key role in initiating workup for crystalluria and urolithiasis. Focused histories and physical examinations were important in those cases with constipation as a cause of reversible flank pain

Comparative analysis and interobserver variation of unenhanced computed tomography and intravenous urography in the diagnosis of acute flank pain

The purpose of this study was to compare unenhanced computed tomography [UECT] to intravenous urography [IVU] for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement. In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients [27 males and 9 females] participated. Mean age was 44 +/- 15 years [range: 14-73 years].The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values <0.05 were considered significant. UECT detected stones in 11 [30.6%] patients, while IVU found them in only 8 [22.2%]. The increased detection by UECT was due to its ability to detect smaller stones [<6 mm]. UECT was also found to be better than IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU. UECT showed better detectability and interobserver agreement than IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic

Non contrast helical CT scan for acute flank pain: non calculus urinary and extra urinary causes

To determine the value of non contrast helical CT in the diagnosis of non calculus renal and extraurinary causes of acute flank pain. A prospective descriptive study. Radiology Department, Aga Khan University Hospital Karachi from January 2005 to June 2005. 130 consecutive patients with acute flank pain underwent Noncontrast enhanced helical CT scan [NHCT]. 100[73%] were male and 30[23%] were female. Scans were observed for noncalculus renal and extraurinary causes of acute flank pain. Out of 130 patients, 30 patients were excluded. In 23[23%] patients non calculus causes of pain were diagnosed. In 5 [5%] patients incidental findings were recorded which were most likely not cause of pain. Three patients had non calculus renal abnormalities which included renal cell carcinoma, horseshoe kidney adult polycystic kidney disease. The accurate and timely diagnosis of an obstructing ureteral calculus, a non calculus urinary abnormality or an extra urinary tract pathology, establishes non contrast helical CT as the diagnostic study of choice for the evaluation of patients with flank pain

Correlation of radiological and clinical features of metanephric neoplasms in adults.

The main objective was to determine the clinical and radiological features of metanephric neoplasms. The tumors were diagnosed on histopathological examination. The clinical data and imaging features were retrospectively analyzed. Between 1998 and 2003, 3 patients underwent radical nephrectomy for renal masses turning out as metanephric neoplasms on histopathology. Two of these tumors were metanephric adenoma (MA) and one was metanephric adenofibroma (MAF). Clinical and radiological features were reviewed. All patients were adult females who presented with flank pain. Tumor was detected on screening ultrasound as a hyperechoic lesion. In all cases CT showed a hyper-attenuating exophytic lesion with cystic areas that enhanced with IV contrast. Based on combination of clinical and imaging features it may be possible to prospectively identify metanephric neoplasms and thus avoid unnecessary radical nephrectomy in favor of conservative surgery.

Hydronephrosis by an Aberrant Renal Artery: A Case Report

Ureteropelvic junction obstruction is usually intrinsic and is most common in children. Aberrant renal arteries are present in about 30% of individuals. Aberrant renal arteries to the inferior pole cross anteriorly to the ureter and may cause hydronephrosis. To the best of our knowledge, although there are some papers about aberrant renal arteries producing ureteropelvic junction obstruction, there is no report of a case which is diagnosed by the new modalities, such as computed tomography angiogram (CTA) or magnetic resonance angiogram (MRA). We describe a 36-year-old woman with right hydronephrosis. Kidney ultrasonogram and excretory urogram revealed right hydronephrosis. CTA and MRA clearly displayed an aberrant renal artery and hydronephrosis. The patient underwent surgical exploration. For the evaluation of hydronephrosis by an aberrant renal artery, use of CTA and MRA is advocated.