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Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results
Jonathan S Luchs1, Douglas S Katz, Michael J Lane
1Department of Radiology, Winthrop-University Hospital, Mineola, New York 11501, USA.
Insights
Microscopic urinalysis for hematuria (blood) has 84% sensitivity for detecting renal colic but low specificity and negative predictive value. Blood in urine cannot reliably confirm or exclude ureteral stones.
Area of Science:
- Urology
- Nephrology
- Radiology
Background:
- Renal colic is a common condition often diagnosed using imaging and urinalysis.
- Hematuria is frequently present in patients with renal colic, but its diagnostic utility requires evaluation.
Purpose of the Study:
- To assess the diagnostic accuracy of hematuria testing in suspected renal colic.
- To compare hematuria testing against unenhanced helical computed tomography (CT) as the gold standard.
Main Methods:
- Retrospective review of 950 patients with suspected renal colic.
- Analysis of microscopic urinalysis results within 24 hours of unenhanced helical CT.
- Calculation of sensitivity, specificity, positive predictive value, and negative predictive value for hematuria.
Main Results:
- Urolithiasis was confirmed in 62% of patients.
- Hematuria testing showed 84% sensitivity but only 48% specificity for renal colic.
- Positive and negative predictive values were 72% and 65%, respectively.
Conclusions:
- Hematuria testing demonstrates high sensitivity but low specificity for diagnosing renal colic.
- The presence or absence of hematuria alone is insufficient for reliably diagnosing ureteral stones.
- Unenhanced helical CT remains the reference standard for diagnosing renal colic.
Objectives:
To determine the utility of hematuria testing in a large series of patients with suspected renal colic using unenhanced helical computed tomography (CT) as the reference standard.
Methods:
A retrospective review of the CT reports of all patients who underwent unenhanced helical CT for suspected renal colic at one institution during a 3.5-year period and who also underwent a formal microscopic urinalysis within 24 hours of the CT study was conducted. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of any blood on the urinalysis for renal colic were calculated.
Results:
Urolithiasis was present in 587 (62%) of the 950 patients, and 363 patients had negative examinations for renal colic, including 69 with significant alternative diagnoses in the latter group. Of the urinalyses, 492 were true-positive, 174 were true-negative, 189 were false-positive, and 95 were false-negative, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 48%, 72%, and 65%, respectively. Forty-six percent of the urinalysis results were negative for blood in the subset of patients with significant alternative diagnoses.
Conclusions:
The sensitivity of hematuria on microscopic urinalysis for renal colic using unenhanced CT as the reference standard was 84%, and the specificity and negative predictive value was low. The presence or absence of blood on urinalysis cannot be used to reliably determine which patients actually have ureteral stones.
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