| Research background:Urological stones have gradually become a global healthcare problem,affecting people in both developed and developing countries.Its prevalence is increasing,and its recurrence rate is high after treatment.Despite advances in treatment,effective treatment strategies are still needed for emerging and recurrent stones to reduce the physical and economic burden of stone disease.recurrent stone formation should undergo metabolic evaluation and stone chemical analysis,including stone composition analysis,serum biochemical examination,24-hour urine ion analysis,urine routine and urine bacterial culture.Metabolic evaluation can not only identify the potential risk factors affecting stone formation to provide the basis for clinical treatment,but also play an extremely important guiding role in preventing stone recurrence.Papilla calcified plaque(Randall’s plaque),known as Randall plaque,is a kind of calcium salt plaque present under the epithelial tissue of renal papilla.Randall plaque is most common in patients with calcium oxalate stones,and is extremely important in the pathogenesis of calcium oxalate kidney stones.It is currently considered to be the starting lesion of stone disease.The severity of calcification in renal papilla may increase the risk of stone occurrence and recurrence in the future.The imaging changes of renal papilla is a new idea for clinical stone research.Based on the Randall plaque theory,this paper studies the correlation between the change of CT attenuation value of renal papilla and the formation and recurrence of stones,and explores the related mechanism of the formation of stones.Objective:Through a retrospective case analysis,the CT attenuation value of renal papilla tip in stone patients was determined to explore the correlation between the occurrence and development of calcium oxalate stones and the radiographic changes of renal papilla.method:A retrospective analysis of 153 patients with calcium oxalate kidney stones hospitalized in the First Affiliated Hospital of Soochow University from December 2019 to December 2022,including 100 patients with first attack(primary stone group),53 patients with stone recurrence(recurrent stones group),and 30 health examinations in the same period were selected as the control group.Plain CT was used to compare the CT decay value of the three groups,the differences in clinical index of the two groups were further observed,the optimal threshold value(Receiver Operating Characteristic,ROC)curve was applied,and the predictive value of different indicators for calcium oxalate stone recurrence was compared by the area under the curve(Area Under the Curve,AUC).The difference indicators were univariate and multivariate Logistic regression analysis,and finally K-M plots were drawn for patients with recurrent stones.Results:The CT attenuation value of renal nipple in the recurrent stone group and primary stone group was significantly higher than that in the control group,and there was no significant difference between the affected side and the healthy side,stone calyx and non-stone calyx;the proportion of hypertension,hyperlipidemia,renal nipple CT attenuation value,24h urinary oxalate,24h urinary citrate,and 24h urinary calcium were statistically significant between the primary stone group and recurrent stone group(p<0.05).Further performed by multivariate Logistic regression analysis,The results showed:The CT value of renal papilla≥39.135HU(OR=10.468,95%CI 3.944～45.659,p=0.001),24h urinary oxalate≥ 0.435mmol/24h(OR=6.394,95%CI 2.248～26.844,p=0.011),24h urinary citrate≤0.752mmol/24h(OR=9.632,95%CI 2.248～41.271,p=0.002)was an independent influencing factor for the recurrence of calcium oxalate stones.The recurrence time of patients with high nipple density was significantly less than that of patients with low nipple density;ROC curve showed that the AUC of 24h urinary oxalate,24h urinary citrate and 24h urinary calcium were 0.819、0.7001、0.745 and 0.630,respectively,which were all predictors of recurrence of calcium oxalate stones.Conclusion:1、Patients with calcium oxalate with high renal papilla density have a higher risk of stone formation and recurrence,and the increase of renal papilla density is an early warning signal for the development of stones2、The CT values of renal papilla≥ 39.135HU,24h urinary oxalate≥ 0.435mmol/24h,and urinary citrate≤0.752mmol/24h were independent risk factors for recurrence of calcium oxalate stones3、The time of recurrence of the stone in patients with high nipple density was significantly less than that in patients with low nipple density... |
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