European Journal of Molecular & Clinical Medicine

Background: Factors that place a patient at risk for renal calculus formation are overall poorly understood. The concept of super saturation is essential to theories on calculus formation.The current study aimed to evaluate the role of dual energy computed tomography in determination of renal stone chemical composition which will effect there treatment strategy. Patients and methods: This study included 48 patients with nephrolithiasis who underwent non contrast CT study for evaluation using dual energy CT at private radiology center. Results: There was statistically significant difference between patients with different stone composition regarding location where (50.0%, 20.0% & 50.0%) of uric, Ca oxalate and cysteine stones respectively were in renal pelvic while all of upper calyceal kidney were cysteine stones. Also, there was statistically significant difference between patients with different stone compositionre garding clinical picture. Regarding age, sex and laterality, there was no statistically significant association with the different stones types. Patients underwent to extracorporeal shock wave lithotripsy were 54% and patients underwent to percutaneous nephrolithotomy were 21%. There was excellent agreement between DECT and crystallography on detection of stone types with (97.9%) success and (2.1%) failure rate of detection when using crystallography as a confirmatory test to DECT with identical results. Conclusion: Dual energy CT provides the anatomical information as number, location,maximal diameter, CT density and also characterize the stone chemical composition which use of this technique could help doctor and patient select appropriate treatment and avoid more invasive & high impact procedures.

The epidemiological relationship between nephrolithiasis and hypertension is well-known. Patients with hypertension are at increased risk for nephrolithiasis and those with nephrolithiasis are at risk for hypertension. An anomaly in RBC Oxalate transport and reduced activities of adenosine triphosphatases has been reported in patients with hypertension when compare to control subjects. This study presents an abnormal increase in transmembrane flux of oxalate in RBC of hypertensive subjects and it might be due to membrane degradation caused by oxalate-induced free radicals depleting erythrocyte thiol contents and impaired adenosine triphosphatases activity resulting in tissue injury and defective membrane transport. Thus relative risk of hypertension was significantly associated with increased oxalate flux rate and impaired adenosine triphosphatases activity in stone formers. This association is important when treating patients with nephrolithiasis since those with hypertension may require unique dietary and medical therapy.