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The relationship between renal scarring and stone disease
1Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032.
AJR. American Journal of Roentgenology
|December 1, 1988
Summary
Upper tract stone disease, not vesicoureteral reflux, is the primary cause of renal caliceal clubbing and scarring in adults. This study analyzed IV urograms in 1500 patients to determine the etiology of this common renal abnormality.
Area of Science:
- Nephrology
- Urology
- Radiology
Background:
- Focal clubbing of renal calices and parenchymal scarring are typically attributed to chronic pyelonephritis, often linked to vesicoureteral reflux.
- However, clinical observation suggests upper tract stone disease may be a more frequent precursor or concurrent condition in adults.
Purpose of the Study:
- To investigate the hypothesis that upper tract stone disease is the most common cause of caliceal clubbing and parenchymal scarring in adults.
- To differentiate the etiological roles of stone disease versus vesicoureteral reflux in this renal abnormality.
Main Methods:
- Retrospective analysis of intravenous urograms from 1500 consecutive adult patients.
- Assessment for evidence of upper tract stone disease, vesicoureteral reflux, caliceal clubbing, and parenchymal scarring.
Main Results:
- In 39 patients exhibiting caliceal clubbing and scarring, 67% had associated stone disease, while only 8% reported a history of reflux.
- Among 90 patients with upper tract stone disease, 29% demonstrated caliceal clubbing and scarring.
Conclusions:
- Upper tract stone disease is identified as a significant, potentially primary, etiological factor in the development of renal caliceal clubbing and parenchymal scarring in the adult population.
- The findings challenge the traditional attribution to chronic pyelonephritis secondary to vesicoureteral reflux.