STONE Score as a Triage Tool to Guide Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB) Requests in Suspected Renal Colic: A Quality Improvement Initiative (2025)

Type of publication:

Journal article

Author(s):

*Hassouba, Omar Nasr; Abdullah Omar, Abdulaziz Alsamani; Awan, Manahil; Ahmad, Shahzad; Taha, Mawada; Venkatachalapathi, Sharmila; Abouelsadat, Mohamed K; Mercy, Albina; Sahnon, Abdelrahman Sahnon Abaker; Shafique, Usama; *Herman, Dodi I.

Citation:

Cureus. 17(9):e92080, 2025 Sep.

Abstract:

Introduction Urolithiasis is a frequent cause of emergency department (ED) visits, with computed tomography (CT) being the gold standard for diagnosis. Excessive imaging increases radiation exposure and healthcare costs. The STONE score is a validated clinical prediction tool, designed to estimate the probability of ureteric stones and reduce unnecessary imaging. Objective The main objective of this study is to evaluate the diagnostic accuracy of the STONE score in patients presenting with flank pain. Methodology This is a cross-sectional retrospective review conducted at the Shrewsbury and Telford Hospital NHS Trust (SATH), Shrewsbury, England, over a four-month period from April 1, 2023, to July 31, 2023. This quality improvement initiative reviewed 81 eligible ED patients who underwent computed tomography of the kidneys, ureters, and bladder (CT-KUB) for suspected ureteric stones. Demographic, clinical, laboratory, and imaging data were collected. STONE scores were calculated for all patients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results The mean age was 38.5 +/- 16.1 years; 35 (43.2%) were male. Ureteric stones were confirmed in 15/19 (78.9%) high-risk, 9/45 (20%) moderate-risk, and 0/17 (0%) low-risk patients. The STONE score yielded an area under the curve (AUC) of 0.879, with a sensitivity of 91.7% and a specificity of 66.7%. Alternative diagnoses included gallbladder stones, appendicitis, cystitis, diverticulitis, hydronephrosis, renal angiomyolipoma, polycystic kidney disease (PCKD), pyelonephritis, and small bowel obstruction (SBO). Conclusion The STONE score demonstrates good diagnostic accuracy, particularly in high-risk patients, and may help reduce unnecessary CT imaging and radiation exposure in the ED.

DOI: 10.7759/cureus.92080

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Fabry disease in the haemodialysis population: outcome of a UK screening study (SoFAH) (2025)

Type of publication:

Journal article

Author(s):

Ng, K P; Sandhu, M; Banerjee, D; Burton, J O; Crowley, L; Doulton, T; Hameed, M A; Hamer, R; Menon, M; *Nicholas, J; Ramakrishna, S B; Shivakumar, K; Geberhiwot, T; Dasgupta, I.

Citation:

BMC Nephrology. 26(1):259, 2025 May 26.

Abstract:

BACKGROUND AND HYPOTHESIS: Fabry disease (FD) is an X-linked inherited disorder with an estimated prevalence among the end-stage kidney disease (ESKD) population of 0.3% in men and 0.1% in women [1]. Due to its non-specific manifestations, FD (especially the later-onset variant) is often underdiagnosed [2]. We aimed to estimate its prevalence in a large haemodialysis (HD) population in the UK.

METHODS: This is a cross-sectional, multicentre study of eight renal centres in the UK. All male participants were tested via dried blood spot alpha-galactosidase A (AG) enzyme and globotriaosylsphingosine (Lyso-Gb3) assays. If either the AG (<= 2.8 micromol/L/H) or Lyso-Gb3 (>= 3.5 ng/mL) level was abnormal, genetic testing for GLA variant was performed. All females had AG, Lyso-GB3 and genetic tests.

RESULTS: In total, 1325 consented to participate in the study. The mean age of the participants was 64 (SD 15) years, 67% were male, 64% were of white ethnicity, the duration of dialysis was 32 (IQR 56) months, and 32% underwent renal biopsy. Diabetic nephropathy (28%) was the most common cause of ESKD, whereas 21% had an unknown aetiology. A total of 1,295 had both AG and Lyso-Gb3 tests, whereas 573 had GLA genetic tests. Among the 14% (n = 186) with an AG level <= 2.8 micromol/L/H, 48 were female and 138 were male, all of whom had Lyso-Gb3 < 3.5 ng/mL. Only 3 (0.2%) had abnormal Lyso-Gb3 but all had normal AG and negative genetic tests. Two females were found to have likely benign, non-pathogenic GLA variants: heterozygous c.937G > T (p.(Asp313Tyr) and heterozygous c.1102G > A (p.(Ala368Thr)).

CONCLUSIONS: Despite the implementation of stringent screening criteria, we did not identify any new confirmed cases of Fabry disease in this large UK haemodialysis population.

DOI: 10.1186/s12882-025-04127-x

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Description and Cross-Sectional Analyses of 25,880 Adults and Children in the UK National Registry of Rare Kidney Diseases Cohort (2024)

Type of publication:

Journal article

Author(s):

Wong K.; Pitcher D.; Braddon F.; Downward L.; Steenkamp R.; Masoud S.; Annear N.; Barratt J.; Bingham C.; Coward R.J.; Chrysochou T.; Game D.; Griffin S.; Hall M.; Johnson S.; Kanigicherla D.; Karet Frankl F.; Kavanagh D.; Kerecuk L.; Maher E.R.; Moochhala S.; Sayer J.A.; Simms R.; Sinha S.; Srivastava S.; Tam F.W.K.; Thomas K.; Turner A.N.; Walsh S.B.; Waters A.; Wilson P.; Wong E.; Sy K.T.L.; Huang K.; Ye J.; Nitsch D.; Saleem M.; Bockenhauer D.; Bramham K.; Gale D.P.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Kpodo F.J.-B.; Bansal T.; Barratt A.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Boddana P.; Bond S.; Branson A.; Brearey S.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Hamilton P.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Frankl F.K.; Karim M.; Kaur A.; Kearley K.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.; Roufosse C.; Rumjon A.; Salama A.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Sinha M.; Smith K.; Smith L.; Stott I.; Stroud K.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Tse Y.; Turnbull A.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.;

Citation:

Kidney International Reports. 9(7) (pp 2067-2083), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Introduction: The National Registry of Rare Kidney Diseases (RaDaR) collects data from people living with rare kidney diseases across the UK, and is the world's largest, rare kidney disease registry. We present the clinical demographics and renal function of 25,880 prevalent patients and sought evidence of bias in recruitment to RaDaR.

Method(s): RaDaR is linked with the UK Renal Registry (UKRR, with which all UK patients receiving kidney replacement therapy [KRT] are registered). We assessed ethnicity and socioeconomic status in the following: (i) prevalent RaDaR patients receiving KRT compared with patients with eligible rare disease diagnoses receiving KRT in the UKRR, (ii) patients recruited to RaDaR compared with all eligible unrecruited patients at 2 renal centers, and (iii) the age-stratified ethnicity distribution of RaDaR patients with autosomal dominant polycystic kidney disease (ADPKD) was compared to that of the English census.

Result(s): We found evidence of disparities in ethnicity and social deprivation in recruitment to RaDaR; however, these were not consistent across comparisons. Compared with either adults recruited to RaDaR or the English population, children recruited to RaDaR were more likely to be of Asian ethnicity (17.3% vs. 7.5%, P-value < 0.0001) and live in more socially deprived areas (30.3% vs. 17.3% in the most deprived Index of Multiple Deprivation (IMD) quintile, P-value < 0.0001).

Conclusion(s): We observed no evidence of systematic biases in recruitment of patients into RaDaR; however, the data provide empirical evidence of negative economic and social consequences (across all ethnicities) experienced by families with children affected by rare kidney diseases.

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Overlap between dermatomyositis and ANCA vasculitides (2014)

Type of publication:
Journal article

Author(s):
*Yuste C., *Rapalai M., *Pritchard B.A., *Jones T.J., *Amoasii C., *Al-Ansari A., *Ramakrishna S.B.

Citation:
Clinical Kidney Journal, February 2014, vol./is. 7/1(59-61), 2048-8505;2048-8513 (February 2014)

Abstract:
We present the second report of the association between antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis with dermatomyositis (DM). A 47-year-old woman suddenly developed rapidly progressive renal failure in the context of (DM). The kidney biopsy showed focal and segmental necrotizing glomerulonephritis with crescent formation. Cyclophosphamide treatment was commenced resulting in a significant recovery of kidney function and maintenance of recovery at 6 months. Although the pathophysiology is unknown, we hypothesize that CD8-T-deficient cells and MPO+ neutrophils in the DM lesions play an important role in the disease process.

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Nephrotic-range proteinuria on interferon-beta treatment: Immune-induced glomerulonephritis or other pathway? (2014)

Type of publication:
Journal article

Author(s):
*Yuste C., *Rapalai M., *Pritchard B.A., *Jones T.J., Tucker B., *Ramakrishna S.B.

Citation:
Clinical Kidney Journal, April 2014, vol./is. 7/2(190-193), 2048-8505;2048-8513 (April 2014)

Abstract:
We present a case report of a 37-year-old woman with multiple sclerosis (MS) who developed nephrotic-range proteinuria secondary to membrano proliferative glomerulonephritis (MPGN)-like disease with mesangial C3 deposition without evidence of immune-complex deposition in the context of long-term interferon-beta (IFN-beta) therapy. The complete remission of proteinuria following cessation of IFN-beta, strongly suggests causality. To our knowledge, this is the second case report of MPGN associated with IFN-beta use. This being the case, the negative immune screen, normal inflammatory markers and the absence of immune complex deposits would imply a different pathway to that previously suggested.

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