Prediction for spontaneous passage of ureteral stones with renal insufficiency

We sought to identify the predictors of spontaneous stone passage (SSP) in patients with ureteral stones, specifically those complicated by renal insufficiency and thus at greater risk for requiring intervention. Retrospective cohort study was performed for patients with ureteric stones and renal insufficiency who received conservative treatment at The Second Affiliated Hospital of Hainan Medical University from May 2015 to May 2025. Data regarding clinical, radiological and inflammatory findings were obtained from medical records. The primary outcome was SSP, defined as spontaneous confirmed or imaged clearance within 4 weeks; failure was intervention or residual stones at 4-weeks. Statistical analyses: logistic regression (univariate/multivariate), receiver operating characteristic(ROC) curve analysis. In 152 of the patients (32.8%), SSP was achieved while it failed in 311patients(67.2%) Patients in both groups had significant differences with respect to serum creatinine, GFR and stone related parameters including stone location, hydronephrosis grade, largest transverse diameter of calculus density (p < 0.05), maximum ureter wall thickness(UWT), dialysis-dependent and daily urine volume alone using the results of univariate analysis that demonstrate a significantly different relationship between patient subgroups as outlined above. Multivariate logistic regression showed that higher GFR (OR = 1.039, 95% CI: 1.013–1.066, p = 0.003), distal ureteral stone location (OR = 1.692, 95% CI: 1.006–2.844, p = 0.047), smaller diameter of the stones' transverse diameter(OR = 0.726, 95% CI: 0.629–0.837, p < 0.001), absence of dialysis therapy before SSP(OR = 0.161, 95% CI: 0.041–0.629, p = 0.009], and higher average daily urine output (OR = 1.002, 95% CI: 1.001–1.002, p < 0.001). The Area under the cure(AUC) of the ROC curve for our predictive model was all good equal to 0.879 (95% CI: 0.846–0.911). This is the first attempt to approach SSP predictors in renal insufficiency patients with a striking systematic analysis. The identified factors and predictive model might facilitate other physicians to decide the optimum approach in terms of conservative management, with early intervention as required, hence avoiding complications and preserving renal function through timely interventions in this high-risk group.