The Value of Split Renal Function in Severe Neonatal and Infant Pelviureteric Obstruction Managed by Percutaneous Nephrostomy

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

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Functional Outcomes After Percutaneous Nephrostomy in Hydronephrotic Kidneys in Adult Population

Bangladesh Journal of Urology ◽

10.3329/bju.v21i2.49880 ◽

2020 ◽

Vol 21 (2) ◽

pp. 93-97

Author(s):

Md Muazzam Hossan ◽

Md Fazal Naser ◽

Md Rokonuzzaman Khan ◽

Md Amirul Islam ◽

Md Golam Kabir

Keyword(s):

Renal Function ◽

Specific Gravity ◽

Adult Population ◽

Percutaneous Nephrostomy ◽

Repeated Measure ◽

Functional Improvement ◽

Nephrostomy Tube ◽

College Hospital ◽

Split Renal Function ◽

Hospital Patients

Objective: To evaluate the results of renal function after percutaneous nephrostomy in hydronephrotic kidneys in adult population. Methods: This study was performed on 57 patients of more than 18 years of age with hydronephrosis due to PUJ obstruction and split renal function <10% at the Department of Urology, Dhaka Medical College Hospital. Patients with concomitant pathologies like stone, pyonephrosis and VUJ obstruction were excluded from the study. Their evaluation included split renal function (SRF),glomerular filtration rate (GFR),specific gravity of urine draining through nephrostomy tube,volume of urine through nephrostomy tube. Statistical analysis was performed by SPSS version 13 and the test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. Results: Mean age of the patients was 33.4+13.0 years, mean SRF increased from 6.2% at baseline to 18.6% after 6 weeks of PCN (p < 0.001), mean GFR increased from 6.2 ml/min/1.73 sq-meter at baseline to 18.6 ml/min/1.73 sq-meter at the end of week 6,mean specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks, volume of urine at 2nd week was 316 ml/ 24 hours and nearly 363 ml/ 24 hours after 6 weeks of PCN (p < 0.001).GFR and SRF improved in 78.95% case Conclusions: Most of the poorly functioning hydronephrotic kidneys showed functional improvement following PCN and hence not all such kidneys should be removed without subjecting them to a trial of PCN. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.93-97

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Improved Split Renal Function after Percutaneous Nephrostomy in Young Adults with Severe Hydronephrosis Due to Ureteropelvic Junction Obstruction

The Journal of Urology ◽

10.1016/j.juro.2014.07.005 ◽

2015 ◽

Vol 193 (1) ◽

pp. 191-195 ◽

Cited By ~ 5

Author(s):

Shiwei Zhang ◽

Qing Zhang ◽

Changwei Ji ◽

Xiaozhi Zhao ◽

Guangxiang Liu ◽

...

Keyword(s):

Young Adults ◽

Renal Function ◽

Ureteropelvic Junction Obstruction ◽

Percutaneous Nephrostomy ◽

Ureteropelvic Junction ◽

Split Renal Function

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Evaluation of Renal Function After Percutaneous Nephrostomy in Obstructive Uropathy Due to Ureteropelvic Junction Obstruction

Bangladesh Journal of Urology ◽

10.3329/bju.v17i1.49112 ◽

2020 ◽

Vol 17 (1) ◽

pp. 36-41

Author(s):

Md Faisal Islam ◽

SM Mahbub Alam ◽

Md Babrul Alam ◽

MA Awal ◽

Md Amanur Rasul

Keyword(s):

Renal Function ◽

Specific Gravity ◽

Filtration Rate ◽

Ureteropelvic Junction Obstruction ◽

Obstructive Uropathy ◽

Percutaneous Nephrostomy ◽

Ureteropelvic Junction ◽

Upj Obstruction ◽

Split Renal Function ◽

The Mean

Objective: The present prospective study was conducted to evaluate the renal function after percutaneous nephrostomy (PCN) in obstructive uropathy due to ureteropelvic junction obstruction. Patients of UPJ obstruction irrespective of sex upto 15 years of age and split renal function (SRF) of the affected kidney <10% were enrolled in the study. Methods: The present prospective study was carried out at the Department of Urology, Dhaka Medical College Hospital from January 2007 to December 2008. The patients having ureteropelvic junction (UPJ) obstruction with poor renal function were the study population. Patients of either sex up to 15 years of age and split renal function < 10% (unilateral and / bilateral) were enrolled in the study. Patients with other anatomical abnormality of urinary system, concomitant pathologies like stone, pyonephrosis or previous surgical intervention of kidney and/or ureter were excluded from the study. Baseline variables were flank mass, flank pain, side of hydronephrosis, split renal function (SRF), glomerular filtration rate (GFR), specific gravity of urine at the time of PCN. Postoperative follow up variables (at 2, 4 and 6 weeks) were split renal function (SRF), glomerular filtration rate (GFR), specific gravity urine draining through nephrostomy tube, volume of urine through nephrostomy tube and complications. Data were collected using a structured questionnaire (research instrument) containing all the variables of interest. Data were processed and analysed using SPSS (Statistical Package for Social Sciences). The test statistics used to analyse the data were descriptive statistics and Repeated measure ANOVA. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Result: The mean age of the patients was 8.6 ± 3.9 years and the lowest and highest ages were 3 months and 15 years respectively. The poorly functioning kidneys demonstrated a steady increase in SRF from 3.6% at baseline to 23% after 6 weeks PCN (p < 0.001). SRF of all children except 4 improved significantly during the period. The mean GFR of poorly functioning kidneys was 3.5ml/min/1.73 sq-meter at baseline which increased to 28.4 ml/min/1.73 sq-meter at the end of week 6. The GFR of 34 children improved (> 10 ml/min/1.73 sq-meter at the 6 week of treatment. Four cases (10.5%) did not improve. The specific gravity of urine significantly increased from 1.009 at baseline to 1.019 after 6 weeks. The volume of urine at 2nd week was 338 ml/24hour which sharply increased to 363 ml/24 hours at week 4 and nearly 386 ml/24hours after 6 weeks of PCN (p < 0.001). Conclusion: Present study recommends that as the likelihood of recovery of a severely damaged kidney (SRF < 10%) with UPJO following PCN is fairly satisfactory; none of the children with poorly functioning kidney should undergo nephrectomy without subjecting them to a PCN trial. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.36-41

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99mTc-DTPA dynamic SPECT and CT volumetry for measuring split renal function in live kidney donors

Annals of Nuclear Medicine ◽

10.1007/s12149-010-0349-y ◽

2010 ◽

Vol 24 (3) ◽

pp. 189-195 ◽

Cited By ~ 19

Author(s):

Chihoko Miyazaki ◽

Hiroshi Harada ◽

Noriyuki Shuke ◽

Atsutaka Okizaki ◽

Masayoshi Miura ◽

...

Keyword(s):

Renal Function ◽

Dynamic Spect ◽

Ct Volumetry ◽

Kidney Donors ◽

Split Renal Function

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Surgery-Related Outcomes and Postoperative Split Renal Function by Scintigraphy Evaluation in Robot-Assisted Partial Nephrectomy in Complex Renal Tumors: An Initial Case Series

Journal of Endourology ◽

10.1089/end.2014.0042 ◽

2015 ◽

Vol 29 (1) ◽

pp. 29-34 ◽

Cited By ~ 4

Author(s):

Kazushi Tanaka ◽

Junya Furukawa ◽

Katsumi Shigemura ◽

Nobuyuki Hinata ◽

Takeshi Ishimura ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Case Series ◽

Renal Tumors ◽

Robot Assisted ◽

Split Renal Function

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Renal functional improvement after pediatric pyeloplasty in kidneys with split renal function less than 20%: a single institute experience

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00084-w ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Elsayed Salih ◽

Ibrahim Abdelmaksoud ◽

Mohamed Elfeky ◽

Gamal Selmy ◽

Hussein Galal ◽

...

Keyword(s):

Renal Function ◽

Statistical Significance ◽

Functional Improvement ◽

Renal Unit ◽

Poor Renal Function ◽

Split Renal Function ◽

Renal Function Deterioration ◽

Number Of Patients ◽

The Mean

Abstract Background Pediatric pyeloplasty in ureteropelvic junction obstruction (UPJO) is indicated in renal impaired drainage or renal function deterioration. The improvement of renal function after pediatric pyeloplasty is still controversial in poorly functioning kidneys. Past studies on poorly functioning kidneys had a variable SRF specification, and these studies often had a limited number of patients so that they did not achieve statistical significance. The study aims to detect the renal functional improvement after pediatric Anderson-Hynes pyeloplasty (AHP) with split renal function (SRF) less than 20% (poor renal function). Results A retrospective study included 46 pediatric patients with unilateral UPJO who underwent open AHP with SRF < 20% on a renal isotope scan from August 2012 to October 2018. Success was defined based on either improvement in symptoms, improvement in drainage on postoperative renography, and/or improvement or stability in SRF on the renal scan done 6 months postoperatively and yearly thereafter. Deterioration of SRF by more than 5% was deemed to be deterioration. An increase in SRF of more than 5% was deemed to be an improvement. A total of 46 patients with a mean age of 32 months with poor renal function on isotope renogram (SRF < 20%) were included. All patients had an obstructive pattern on the preoperative radionuclide scans. The median preoperative SRF was 9.26%. The mean (range) follow-up was 30 months. The success rate was 91.3%. Three patients underwent redo pyeloplasty, whereas a secondary nephrectomy was necessary for one. The remaining (42) patients showed stability or improvement of SRF with no further symptoms. Renal scintigraphy at 6 and 12 months after surgery revealed significantly increased SRF compared to preoperative one. Conclusion Poorly functioning renal unit with SRF < 20% can show functional improvement and recoverability after pediatric pyeloplasty.

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Cervical cancer: Renal complications and survival after percutaneous nephrostomy

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.03.255 ◽

2016 ◽

Vol 62 (3) ◽

pp. 255-261 ◽

Cited By ~ 2

Author(s):

Alzira Carvalho Paula de Souza ◽

Alfredo Nunes Souza ◽

Rubens Kirsztajn ◽

Gianna Mastroianni Kirsztajn

Keyword(s):

Blood Pressure ◽

Cervical Cancer ◽

Renal Function ◽

Percutaneous Nephrostomy ◽

Cross Sectional Study ◽

Obstructive Nephropathy ◽

Cross Sectional ◽

Low Blood Pressure ◽

Northern Brazil

SUMMARY Introduction: Obstructive nephropathy is a frequent complication in the course of advanced cervical cancer (CC), and ultrasonography-guided percutaneous nephrostomy (PCN) is a well established technique for fast ureteral desobstruction. Objective: To identify possible factors related to the survival and quality of life of patients with advanced CC presenting acute urinary obstructive complications that after desobstruction by PCN recovered urinary flux and renal function. Method: This is an analytical, descriptive, cross-sectional study that included 45 patients with CC who underwent PCN and were divided into 2 groups: “death” (DG) and “survival” (SG), in a public hospital that is reference for oncologic diseases in Northern Brazil. Results: The mean serum creatinine of the patients preceding PCN was >10 mg/dL, and after PCN <2 mg/dL. The cutoffs of 8.7 g/dL for Hb (p=0.0241) and 27% for Ht (p=0.0065) indicated the values that better discriminate the outcomes of the groups. The presence of low blood pressure was statistically correlated (p=0.0037) to the outcome “death”. Changes in glomerular filtration rate (already reduced in all cases) were not associated to the levels of Hb/Ht or to the outcome “death” during the nephrological follow-up. Conclusion: PCN was responsible for the recovery of renal function in 61.7% of the patients, leading to interruption of renal replacement therapy (RRT) in all of those patients. Hb levels >8.7g/dL and Ht >27% were associated to longer survival, and the presence of low blood pressure during follow-up was associated with progression to death.

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