Diagnostic role of urine C-reactive protein levels on ureteral stone disease
Keywords:
ureter, stone disease, diagnosis, urine C-reactive protein levelAbstract
Objective: To investigate the importance of serum and urine CRP levels in patients with ureteral stone.
Material and Method: Seventy-six patients were included in this study. Forty-nine patients in Group 1 had ureteral stones while 27 healthy volunteers in Group 2 were included as controls. Demographic data, preoperative radiologic imaging and perioperative findings of the patients (including stone size, presence of stone impaction etc.) were recorded. Serum and urine CRP levels were measured on the morning of surgery. Urine CRP was measured by quantitive sandwich enzyme immunoassay technique with Immunodiagnostic brand ELISA kit (BensheimR,Germany).
Result: Twelve stones (24.5%) were found to be obstructive. The mean serum and urine CRP values of participants were; 12.1mg/l and 10.5ng/dl in Group 1, and 1.5mg/l and 6.1ng/dl in Group 2, respectively (pserumCRP=0.002, purineCRP=0.001). The serum and urine CRP levels were found to be 20.2mg/l and 12.8ng/dl for obstructive stones and 9.1mg/l and 9.8ng/dl for non-obstructive stones, respectively (pserum CRP =0.133) (purine CRP =0.492). According to the ROC analysis, the best cut-off value of serum and urine CRP were 2.4mg/l and 6.7ng/dl respectively. The sensitivity, specificity values of the serum and urine CRP measurement were 78.0%, 85.2% and 63.5%, 85.1% respectively.
Conclusion: Serum and urine CRP measurement are candidate to be a new marker for ureteral stones. The usage of serum and urine CRP levels may support presence and impaction of ureteral stone. We believe further studies involving larger series are necessary before more definite conclusions can be drawn.
References
2- Turney BW, Reynard JM, Noble JG, Keoghane SR. Trends in urological stone disease. BJU Int 2012;109:1082-1087.
3- Stamey T. Pathogenesis and Treatment of Urinary Tract Infections. In: Williams & Wilkins, Baltimore 1980, pp 239–241.
4- Dai J, Tang K, Xiao W, Yu G, Zeng J, Li Wet al. Prognostic significance of C-reactive protein in urological cancers: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2014;15:3369-75.
5- Shoag J, Eisner BH. Relationship between C-reactive protein and kidney stone prevalence. J Urol 2014;191:372-75.
6- Ansar W and Ghosh S. C-reactive protein and the biology of disease. Immunol Res 2013;56:131.
7- Moutzouri E, Tsimihodimos V and Tselepis AD. Inflammatory biomarkers and cardiovascular risk assessment. Current knowledge and future perspectives. Curr Pharm Des 2013;19:3827.
8- Meier-Ewert HK, Ridker PM, Rifai N, Price N, Dinges DF, Mullington JM. Absence of diurnal variation of C-reactive protein concentrations in healthy human subjects. Clin Chem 2001;47:426-430.
9- Volanakis JE. Human C-reactive protein: expression, structure, and function. Mol Immunol 2001;38:189.
10- St Sauver JL, Sarma AV, Jacobson DJ, et al. Association between C-reactive protein and benign prostatic hyperplasia/lower urinary tract symptom outcomes in population-based cohort. Am J Epidemiol 2009;169:1281-90.
11- Khuseyinova N, Imhof A, Trischler G, Rothenbacher D, Hutchinson WL, Pepys MB, et al. Determination of C-reactive protein: comparison of three high-sensitivity immunoassays. Clin Chem 2003;49:1691-1695.
12- Cho KJ and Kim JC. Biomarkers for lower urinary tract dysfunction. Int J Urol 2013; 20:13.
13- Tanaka N, Kikuchi E, Shirotake S, Kanao K, Matsumoto K, Kobayashi H, et al. The predictive value of C-reactive protein for prognosis in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy: a multi-institutional study. Eur Urol 2014;65:227-34.
14- Steffens S, Köhler A, Rudolph R, Eggers H, Seidel C, Janssen M, et al. Validation of CRP as prognostic marker for renal cell carcinoma in a large series of patients. BMC Cancer 2012;12:399.
15- Angulo JC, Gaspar MJ, Rodríguez N, García-Tello A, Torres G, Núñez C. The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology 2010;76:301-6.
16- Stuveling EM, Bakker SJ, Hillege HL, de Jong PE, Gans RO, de Zeeuw D. Biochemical risk markers: a novel area for better predictionof renal risk? Nephrol Dial Transplant 2005;20:497-508.
17- Ross R. Atherosclerosis - an inflammatory disease. N Engl J Med 1999;340:115-126.
18-Lu XL, Xiao ZH, Yang MY, Zhu YM. Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis. Nephrol Dial Transplant 2013;28:122-129.
19-Park CH, Ha JY, Park CH, Kim CI, Kim KS, Kim BH. Relationship Between Spontaneous Passage Rates of Ureteral Stones Less Than 8 mm and Serum C-Reactive Protein Levels and Neutrophil Percentages. Korean J Urol 2013;54:615-618.
20-Agrawal P, Pandey A, Sompura S, Pursnani ML. Role of blood C - reactive protein levels in upper urinary tract infection and lower urinary tract infection in adult patients (>16 years). J Assoc Physicians India 2013;61:462-463.
21- Swerkersson S, Jodal U, Sixt R, Stokland E, Hansson S. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol 2007;178:647-651.
22- Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69:475-482.
23-Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A. Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 2005;173:458-462.
24-Wolff JM, Boeckmann W, Mattelaer P, Krämer U, Jakse G. Early detection of infected ureteral obstruction after SWL employing C-reactive protein. J Endourol 1996;10:523-526.
25-Wu TT, Lee YH, Tzeng WS, Chen WC, Yu CC, Huang JK. The role of C-reactive protein and erythrocyte sedimentation rate in the diagnosis of infected hydronephrosis and pyonephrosis. J Urol 1994;152:26-28.
26-El-Assmy A, El-Nahas AR, Youssef RF, El-Hefnawy AS, Sheir KZ. Impact of the degree of hydronephrosis on the efficacy of in situ extracorporeal shock-wave lithotripsy for proximal ureteral calculi. Scand J Urol Nephrol 2007;41:208-213.
27- Picozzi SC, Ricci C, Gaeta M, Casellato S, Stubinski R, Ratti D, et al. Urgent shock wave lithotripsy as first-line treatment for ureteral stones: a meta-analysis of 570 patients. Urol Res 2012;40:725-31.
28-Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2014; 4: CD008509.
29- Chuang YC, Tyagi V, Liu RT , Chancellor MB, Tyagi P. Urine and Serum C-Reactive Protein Levels as Potential Biomarkers of Lower Urinary Tract Symptoms. Urol Sci 2010;21:132−6.
30- Nikibakhsh AA , Mahmoodzadeh H, Hejazi S, Noroozi M, Shfiei H, Gaibi S et al. Evaluation of Quantitative Urinary C-Reactive Protein Levels in Children with Urinary Tract Infection. J Ped Nephrology 2013; 1: 70-73.
