Inflammatory serum markers predicting spontaneous ureteral stone passage

  • Nassib Abou Heidar
  • Muhieddine Labban
  • Gerges Bustros
  • Rami NasrEmail author
Original article



Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. However, predictors of spontaneous ureteral stone passage are still not well understood. We aim to explore the role of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in the spontaneous ureteral stone passage (SSP).


Chart review was done for 619 patients who presented to our institution’s ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone of less than 10 mm. Demographic, clinical, laboratory, and radiological data were collected. The Linear-by-Linear Association test was used to look at the trend among the NLR and PLR quartiles and other demographic variables. Univariate analysis was run for the collected variables. Then, a hierarchal backward multivariate logistic regression was run for each of NLR and PLR variables. To validate the results, bootstrapping was undertaken for each model.


NLR between 2.87 and 4.87 had odds ratio (OR) 2.96 (95% CI 1.80–5.49) and an NLR > 4.87 had 3.63 (2.04–6.69) the odds of retained ureteral stone. A PLR between 10.42 and 15.25 and a PLR > 15.25 had 3.28 (1.79–6.19) and 3.84 (2.28–7.12) the odds of failed SSP, respectively. Other significant variables in the two models are diabetes, urine leukocyte esterase > 10 white blood cell/μl, moderate-to-severe hydronephrosis, and stone size.


NLR and PLR are inversely associated with SSP of ureteral stones. In adjunct with other indicators, NLR and PLR are inflammatory markers that could be used in the clinical decision of ureteral stone management.


Urinary calculi Ureteral stone Renal colic Spontaneous stone passage Inflammatory marker Prognosis 


Supplementary material

10157_2019_1807_MOESM1_ESM.xlsx (139 kb)
Supplementary material 1 (XLSX 139 kb)


  1. 1.
    Picozzi SC, Marenghi C, Casellato S, Ricci C, Gaeta M, Carmignani L. Management of ureteral calculi and medical expulsive therapy in emergency departments. J Emerg Trauma Shock. 2011;4(1):70–6.CrossRefGoogle Scholar
  2. 2.
    Johri N, Cooper B, Robertson W, Choong S, Rickards D, Unwin R. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116(3):c159–71.CrossRefGoogle Scholar
  3. 3.
    Pearle MS, Calhoun EA, Curhan GC. Urologic diseases in America project: urolithiasis. J Urol. 2005;173(3):848–57.CrossRefGoogle Scholar
  4. 4.
    Lotan Y. Economics and cost of care of stone disease. Adv Chronic Kidney Dis. 2009;16(1):5–10.CrossRefGoogle Scholar
  5. 5.
    Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol. 2008;53(2):411–8.CrossRefGoogle Scholar
  6. 6.
    Garcia Morua A, Gutierrez Garcia JD, Martinez Montelongo R, Gomez Guerra LS. Use of alfuzosin for expulsion of stones in the distal third of ureter. Actas Urol Esp. 2009;33(9):1005–10.CrossRefGoogle Scholar
  7. 7.
    Sfoungaristos S, Kavouras A, Katafigiotis I, Perimenis P. Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. BJU Int. 2012;110(8 Pt B):339–45.CrossRefGoogle Scholar
  8. 8.
    Ozcan C, Aydogdu O, Senocak C, Damar E, Eraslan A, Oztuna D, Bozkurt OF. Predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein in patients with 4 to 10 mm distal ureteral stones: a prospective clinical study. J Urol. 2015;194(4):1009–13.CrossRefGoogle Scholar
  9. 9.
    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(9):615–8.CrossRefGoogle Scholar
  10. 10.
    Garcea G, Ladwa N, Neal CP, Metcalfe MS, Dennison AR, Berry DP. Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35(4):868–72.CrossRefGoogle Scholar
  11. 11.
    Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, McMillan DC. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer (Oxford, England: 1990). 2011;47(17):2633–41.CrossRefGoogle Scholar
  12. 12.
    Kahramanca S, Ozgehan G, Seker D, Gokce EI, Seker G, Tunc G, Kucukpinar T, Kargici H. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulusal travma ve acil cerrahi dergisi Turk J Trauma Emerg Surg TJTES. 2014;20(1):19–22.CrossRefGoogle Scholar
  13. 13.
    Kim SY, Kim MJ, Yoon CS, Lee MS, Han KH, Lee MJ. Comparison of the reliability of two hydronephrosis grading systems: the Society for Foetal Urology grading system vs. the Onen grading system. Clin Radiol. 2013;68(9):e484–90.CrossRefGoogle Scholar
  14. 14.
    Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475–82.CrossRefGoogle Scholar
  15. 15.
    Drake T, Grivas N, Dabestani S, Knoll T, Lam T, Maclennan S, Petrik A, Skolarikos A, Straub M, Tuerk C, et al. What are the benefits and harms of ureteroscopy compared with shock-wave lithotripsy in the treatment of upper ureteral stones? A systematic review. Eur Urol. 2017;72(5):772–86.CrossRefGoogle Scholar
  16. 16.
    Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS. Management of ureteral calculi: a cost comparison and decision making analysis. J Urol. 2002;167(4):1621–9.CrossRefGoogle Scholar
  17. 17.
    Saenz Medina J, Alarcon Parra RO, Redondo Gonzalez E, Llanes Gonzalez L, Crespo Martinez L, Fernandez Montarroso L, Duran Poveda M, Paez Borda A. Prognostic factors of spontaneous expulsion in ureteral lithiasis. Actas Urol Esp. 2010;34(10):882–7.CrossRefGoogle Scholar
  18. 18.
    Skolarikos A, Laguna MP, Alivizatos G, Kural AR, de la Rosette JJ. The role for active monitoring in urinary stones: a systematic review. J Endourol. 2010;24(6):923–30.CrossRefGoogle Scholar
  19. 19.
    Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178(1):101–3.CrossRefGoogle Scholar
  20. 20.
    Yamaguchi K, Minei S, Yamazaki T, Kaya H, Okada K. Characterization of ureteral lesions associated with impacted stones. Int J Urol. 1999;6(6):281–5.CrossRefGoogle Scholar
  21. 21.
    Holmlund D. On medical treatment for ureteral stone expulsion. Scand J Urol. 2018;52(2):94–100.CrossRefGoogle Scholar
  22. 22.
    Nuss GR, Rackley JD, Assimos DG. Adjunctive therapy to promote stone passage. Rev Urol. 2005;7(2):67–74.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Aldaqadossi HA. Stone expulsion rate of small distal ureteric calculi could be predicted with plasma C-reactive protein. Urolithiasis. 2013;41(3):235–9.CrossRefGoogle Scholar
  24. 24.
    Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.CrossRefGoogle Scholar
  25. 25.
    Lee KS, Ha JS, Koo KC. Significance of neutrophil-to-lymphocyte ratio as a novel indicator of spontaneous ureter stone passage. Yonsei Med J. 2017;58(5):988–93.CrossRefGoogle Scholar
  26. 26.
    Li B, Zhou P, Liu Y, Wei H, Yang X, Chen T, Xiao J. Platelet-to-lymphocyte ratio in advanced cancer: review and meta-analysis. Clin Chim Acta Int J Clin Chem. 2018;483:48–56.CrossRefGoogle Scholar
  27. 27.
    Hess B. Pathophysiology, diagnosis and conservative therapy in calcium kidney calculi. Therapeutische Umschau Revue therapeutique. 2003;60(2):79–87.CrossRefGoogle Scholar
  28. 28.
    Choi T, Yoo KH, Choi SK, Kim DS, Lee DG, Min GE, Jeon SH, Lee HL, Jeong IK. Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: what is the influence of diabetes mellitus on the ureter? Korean J Urol. 2015;56(6):455–60.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryAmerican University of Beirut Medical CenterBeirutLebanon

Personalised recommendations