الفهرس 
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Abstract
Acute loin pain is a common and complex clinical problem which might be caused by a variety of urinary and extra-urinary abnormalities among which urolithiasis being the most frequent cause.
The diagnosis of renal colic depends on medical history and physical examination, the initial work up of patients presenting with acute
renal colic remains controversial. Traditionally urinalysis, x-ray KUB and US have been done as initial Emergency Room investigations.
Urinalysis is invaluable in the diagnostic workup of urologic conditions such as urinary tract infection (UTI), suspicion of stone disease and suspicion of malignancy. It is simple and inexpensive to perform and the presence of microscopic haematuria on urinalysis has been thought as a sensitive marker for detection of stone.
Plain radiographs are not sensitive to non-radio-opaque calculi or to non-calculous obstruction. Plain radiography also lacks specificity, as phleboliths, which are common pelvic calcifications, are not always readily differentiated from urinary tract calculi.
US, which is universally available, non-invasive, inexpensive and radiation free, is preferred by some radiologists as the initial method for evaluation of the kidneys and bladder. However, US is considered to be of limited value in demonstrating pathological conditions of the ureter.
In our study which included 180 patients presenting with acute loin pain, NECT identified 138 patients with urinary stone disease, 21 patients with non-stone urinary tract pathology (uretero-pelvic junction obstruction , vesico-ureteric junction stricture and cortical cyst), 12 patients with other intra-abdominal pathological findings (ovarian cyst and appendicitis), and 9 patients with no pathological imaging findings. The prevalence of urinary stone disease patients was (76.7%).
In our study 102 (56.7%) patients out of 180 patients with acute renal colic had microscopic haematuria. Sensitivity and specificity of microscopic haematuria were 65.2% and 71.4% respectively. The positive predictive value and negative predictive value for haematuria as a marker for stone disease was 88.24% and 38.46% respectively with high significant p-value (0.001).
In our study 84(46.7%) patients out of 180 patients with acute renal colic had pyuria. Sensitivity and specificity of pyuria were 36.9% and 21.4% respectively. The positive predictive value and negative predictive value for pyuria as a marker for stone disease was 60.71% and 9.37% respectively with high significant p-value (0.001).
the role of NECT in the evaluation of acute abdominal pain in general and loin pain in particular is not shakable. It is diagnostic, rapid, safe, available and cost-effective. It requires no ancillary procedures or preparation and, hence, is most suitable for emergency situations. It diagnoses not only urinary tract stone disease, but a wide variety of urinary non-calcular and extra-urinary tract pathologies as well.
In sum, we believe that urinalysis is a valuable tool in the diagnostic work up of patient with acute renal colic. Especially the presence of RBCs and/or WBCs in the urinalaysis can predict the presence or urinary calculi with good sensitivity and specifity and may be used as a guide for further work up.