scholarly journals Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy

2021 ◽  
Vol 42 (1) ◽  
pp. 1-6
Author(s):  
Sekdusit Aekgawong ◽  
◽  
Patkawat Ramart ◽  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
Operating Characteristics ◽  
Bilateral Hydronephrosis ◽  
Predicting Factors ◽  
Characteristics Analysis ◽  
Siriraj Hospital ◽  
Predicting Factor

Objective: Improvement of renal function in obstructive uropathy is a main goal of urinary diversion. In cases of failed internal diversion, percutaneous nephros-tomy (PCN) is used to divert urine from the obstructed kidney. PCN also affect on quality of life, particularly having both sides. The objective of this study was to identify a predicting factor associated with improvement of renal function after bilateral PCNs and to avoid performing bilateral PCNs. Materials and Methods: Data of all patients with bilateral hydronephrosis asso-ciated with malignancy who were performed bilateral PCNs in Siriraj Hospital between December 2011 and December 2016 were reviewed and collected. Success with PCN was defined as a serum creatinine less than 2 mg/dl or decreased more than 95% of initial serum creatinine. Results: A total of 240 patients met the criteria. Mean age was 64.6 ± 14.9 years old. Most common organ of malignancy was cervix. Mean initial serum creatinine (iCr) and nadir serum creatinine (nCr) were 7.7 and 1.9 mg/dl, respectively. On multivariate analysis, no significant predicting factors were demonstrated but only iCr tended to have a statistically significant (p = 0.058). From receiver operating characteristics analysis, at cut-off value of iCr 5 mg/dl could demonstrate signifi-cant difference between success and failure (p = 0.027). Sensitivity and specificity were 72.4% and 44.0%, respectively. Conclusion: Only the iCr was more likely to be a predicting factor. At cut-off value of iCr 5 mg/dl, if a patient presented with iCr more than 5 mg/dl and unilateral PCN at dominant side did not improve serum creatinine, performing contralateral PCN might not help.

scholarly journals Prognosis of obstructive nephropathy patients after percutaneous nephrostomy

2015 ◽  
Vol 22 (1) ◽  
Author(s):  
Jefri Sukmagara ◽  
H R Danarto
Keyword(s):  
Logistic Regression ◽  
Renal Function ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
Symptom Duration ◽  
Multiple Logistic Regression ◽  
The Relationship

Background: Percutaneous nephrostomy is a life-saving procedure for the treatment of obstructive uropathy associated with septicaemia and uraemia. It is regarded as a temporary interventional procedure before definitive treatment. Several factors can affect recovery of renal function after nephrostomy, such as patient age, duration of obstruction, function of the contralateral kidney, pyelolymphatic backflow and compliance of the ureter and renal pelvis.Objective: To determine factors that can predict the decrease in creatinine levels after percutaneous nephrostomy (< 2mg/dl).Methods: This is a retrospective analysis descriptive study. All patients previously performed nephrostomy at Sardjito General Hospital Yogyakarta, from January 2009 to December 2012 were identified. The data were analyzed to evaluate the relationship between reduction of serum creatinine level and following variables including: etiology, nephrostomy (unilateral or bilateral), symptom duration (≤14 days or >14 days), comorbid disease (hypertension, diabetes melitus, heart disease) and degree of hydronephrosis (mild, moderate and severe). The data were analyzed with Chi-Square test and multiple logistic regression to obtain predictive factor and predictive scoring equation to measure the possibility of recoverability of renal function after nephrostomy.Results: We analyzed 117 patients that previously treated by percutaneous nephrostomy. It showed the relationship between reduction of serum creatinine level and the following variables:  nephrostomy (unilateral or bilateral) (p=0,000), symptom duration (p=0,000), hypertension (p=0,004) and degree of hydronephrosis (p=0,000). Whereas etiology of urinary obstruction and other comorbid diseases showed no relationship. Predictive equation result: P= 1/(1+ey), where y= -0,271 + 1,636 (degree of hydronephrosis) + ((-2,216) unilateral or bilateral nephrostomy) + 1,694 (symptom duration) + ((-0,862) hypertension), with sensitivity 74,3% and specificity 70,7% in predicting renal function recoverability.Conclusions: Bilateral or unilateral nephrostomy, symptom duration, hypertension and degree of hydronephrosis are factors affecting the decrease in serum creatinine level. They role as independent predictor to predict recoverability of renal function can be considered. Key words: obstructive uropathy, percutaneous nephrostomy, multiple logistic regression.

scholarly journals PERCUTANEOUS NEPHROSTOMY FOR RELIEF OBSTRUCTIVE UROPATHY: BENIGN VERSUS MALIGNANT DISEASE

2017 ◽  
Vol 24 (1) ◽  
Author(s):  
Prahara Yuri ◽  
Sungsang Rochadi
Keyword(s):  
Renal Function ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
T Test ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Before And After ◽  
Benign Process ◽  
The Mean ◽  
Ultrasound Guided Puncture

Objective: This study aimed to find out the effectiveness of percutaneous nephrostomy (PCN) as palliative decompression of the obstructed urinary system. Materials & Methods: A case control study was performed with 118 patients (69 female and 49 male) with obstructive uropathy who were undergoing PCN during 2009 until 2012, retrospectively. The mean of age was 50.03 years. The PCN technique involves an ultrasound-guided puncture of the dilated collecting system with nephrostomy trocar than insert an 8 Fr nasogastric tube as nephrostomy catheter. Differences of renal function between benign and malignancy were assessed using Independent t-test. Changes in renal function after procedure were expressed as mean ± SD and analyzed using Pair t-test.  Results: There was no procedure-related mortality. The most cause of malignancy was cervix cancer (36.4%) while the result of a benign process was 28.8% of urinary tract stones. Dialysis before procedure were performed in 43 (36.4%) consisting of 42 malignancies and 1 benign process. Improvement in renal function were statistically significant both benign and malignant groups seen in the levels of creatinine and blood urea nitrogen (BUN) before and after procedure (p<0.001). The mean differences were also statistically significant at the preoperative creatinine values between benign and malignant processes (p=0.019) but BUN levels before and after as well as postoperative creatinine levels showed no significant difference. Conclusion: PCN is a widely used technique, with a high technical success rate and low rate of complications. Obstructive uropathy due to benign processes had a better prognosis than malignancy after PCN treatment. Hemodialysis was mainly performed in patients with malignancy prior to PCN.

scholarly journals Serum Cystatin C as an Endogenous Marker of Renal Function in Patients with Chronic Kidney Disease (CKD)

2018 ◽  
Vol 4 (1) ◽  
pp. 3-12
Author(s):  
Md Anwarul Haque Faraji ◽  
Mohammed Rashed Anwar ◽  
Dilip Kumar Debnath ◽  
Md Babrul Alam ◽  
Syed Mahbub Morshed ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Obstructive Uropathy ◽  
Stage Iv ◽  
Serum Cystatin C ◽  
College Hospital ◽  
Serum Cystatin

Background: Cystatin C is being considered as a potential replacement for serum creatinine as a filtration marker.Objectives: This present study was conducted to determine the validity of Cystatin C as a renal function test and to compare the Cystatin C and serum creatinine level between the CKD cases and person not having CKD.Methodology: The present case control study was conducted in the department of Nephrology of Dhaka Medical College Hospital during the period of January 2009 to December 2009 with the aim to find out the serum Cystatin C as diagnostic markers of chronic kidney disease. In the present study total 100 respondents were included. Among them 50 were CKD patients and another 50 were without CKD. Results: It was an age and sex matched study. Out of 50 patients with CKD, 29 (58.0%) were in the stage IV followed by 15 (30.0%) were in the stage III and rest 6 (12.0%) were in the stage V. In CKD group 31 (62.0%) had glomerulonephritis, 18 (36.0%) had HTN, 11 (22.0%) had DM and 3 (6.0%) had obstructive uropathy.  In without CKD group 9 (18.0%) had HTN, 6 (12.0%) had DM. Mean±SD of Serum Creatinine in CKD and without CKD groups were 5.73±2.69 and 0.85±0.11mg/dl respectively. Mean±SD of Serum Cystatin C in CKD and without CKD groups were 3.59±1.21 and 0.71±0.09 mg/dl respectively. In all patients sensitivity of Cystatin C to diagnose CKD was 100.0% and specificity also100.0%. Sensitivity of serum creatinine to diagnose CKD was 88.0% and specificity was 100.0%.Conclusions: Cystatin C proved more reliable than creatinine and was comparable to plasma creatinine and Cockcroft-Gault estimation. Serum Cystatin C had higher diagnostic accuracy with high sensitivity and specificity to detect renal function and is a reliable marker of renal function. Journal of Current and Advance Medical Research 2017;4(1):3-12

Urinary vimentin mRNA as a potential novel biomarker of renal fibrosis

2015 ◽  
Vol 309 (6) ◽  
pp. F514-F522 ◽  
Author(s):  
Yu-Han Cao ◽  
Lin-Li Lv ◽  
Xu Zhang ◽  
Hong Hu ◽  
Li-Hong Ding ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Fibrosis ◽  
Single Gene ◽  
Predictive Performance ◽  
Noninvasive Detection ◽  
Operating Characteristics ◽  
Kidney Fibrosis ◽  
Characteristics Analysis ◽  
Noninvasive Biomarker ◽  
Noninvasive Biomarkers

Renal fibrosis is a histological outcome of chronic kidney disease (CKD) progression. However, the noninvasive detection of renal fibrosis remains a challenge. Here we constructed a renal fibrosis target mRNA array and used it to detect urinary mRNAs of CKD patients for investigating potential noninvasive biomarkers of renal fibrosis. We collected urine samples from 39 biopsy-proven CKD patients and 11 healthy controls in the training set. Urinary mRNA profiles of 86 genes showed a total of 21 mRNAs that were differentially expressed between CKD patients and controls ( P < 0.05), and vimentin (VIM) mRNA demonstrated the highest change fold of 9.99 in CKD vs. controls with robust correlations with decline of renal function and severity of tubulointerstitial fibrosis. Additionally, VIM mRNA further differentiated patients with moderate-to-severe fibrosis from none-to-mild fibrosis group with an area of the curve of 0.796 ( P = 0.008). A verification of VIM mRNA in the urine of an additional 96 patients and 20 controls showed that VIM is not only well correlated with renal function parameters but also correlated with proteinuria and renal fibrosis scores. Multiple logistic regression and receiver-operating characteristics analysis further showed that urine VIM mRNA is the best predictive parameter of renal fibrosis compared with estimated glomerular filtration rate, serum creatinine, and blood urea nitrogen. In addition, there is no improved predictive performance for the composite biomarkers to predict renal fibrosis severity compared with a single gene of VIM. Overall, urinary VIM mRNA might serve as a novel independent noninvasive biomarker to monitor the progression of kidney fibrosis.

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

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

scholarly journals Measures Undertaken for the Management of Obstructive Uropathy in Advanced Carcinoma Cervix

2020 ◽  
Vol 15 (1) ◽  
pp. 15-17
Author(s):  
Masud Ahmed ◽  
MA Awal ◽  
MA Rashid ◽  
Md Shahadat Hossain ◽  
S Rahman ◽  
...  
Keyword(s):  
Renal Function ◽  
Surgical Procedures ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
Cross Sectional Study ◽  
Study Data ◽  
Carcinoma Cervix ◽  
College Hospital ◽  
Cross Sectional ◽  
Advanced Carcinoma

Objectives: To find out the procedures adopted for the management of obstructive Uropathy in advanced Carcinoma cervix and To identify the most excellent option for their management. Methods: It was a retrospective cross sectional study. Data were collected from patient’s record of Urology outpatient department (OPD) and indoor of Dhaka Medical College Hospital (DMCH) for the year 2010. Patients attended with other causes of obstructive uropathy were excluded. Results: Total 32 patients were included in this study. Mean age of the patients was 46±6.90 years. All of them were squamous cell carcinoma of stage III & IV disease. About 60% patients received pre-operative radiotherapy for cervical cancer. Twenty three patients underwent retrograde ureteral stenting, 6 patients underwent percutaneous nephrostomy (PCN) and rest 3 underwent cutaneous ureterostomy. Mean pre-operative serum creatinin was 2.68±.24 mg/dl. and post-operatively it dropped to 1.30±.05 mg/dl. which is statistically very much significant. Post-operative hydronephrosis also improved significantly following operations. Difference observed in the improvement of renal function or hydronephrosis among the surgical procedures but it was not statistically significant. Conclusion: Any of the surgical procedures undertaken for the management of obstructive uropathy due to advanced carcinoma of cervix, provided significant improvement of renal function and hydronephrosis. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.15-17

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Renal Function ◽  
Low Dose ◽  
Ureteropelvic Junction Obstruction ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
College Hospital ◽  
Medical College ◽  
Split Renal Function

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

scholarly journals Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ismail Zul Khairul Azwadi ◽  
Mohd Noor Norhayati ◽  
Mohd Shafie Abdullah
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Obstructive Uropathy ◽  
Meta Analysis ◽  
Percutaneous Nephrostomy ◽  
Procedural Pain ◽  
Controlled Trials ◽  
Failure Rates ◽  
Ureteral Stenting

AbstractAcute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

scholarly journals Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

2021 ◽  
Vol 05 (01) ◽  
pp. 007-011
Author(s):  
Shaheen Afsal ◽  
K. Sujani ◽  
Shashank Viswanathan ◽  
Akshay Bhati ◽  
Harish BR ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Normal Renal Function ◽  
Artery Bypass ◽  
Significant Proportion ◽  
Renal Dialysis ◽  
Off Pump ◽  
Preoperative Serum

AbstractCardiovascular disease (CVD) is a major cause for a significant proportion of all deaths and disability worldwide. Postoperative renal dysfunction following cardiac surgery is not an uncommon complication of cardiac surgery, which has serious implications with regard to morbidity, mortality, financial expenditure, and resource utilization. This study was performed to compare outcomes of patients with preoperative renal dysfunction with those having normal renal function undergoing off-pump coronary artery bypass grafting (OPCABG). Patients were divided into two categories, depending on their preoperative serum creatinine and glomerular filtration rate (GFR). The preoperative renal dysfunction was defined as serum creatinine >1.3 mg/dL and/or estimated GFR (eGFR) of <60 mL/min/1.73 m2. The category A patients had normal renal function defined as serum creatinine ≤1.3 mg/dL and/or eGFR of ≥60 mL/min/1.73 m2 while the category B patients had preoperative renal dysfunction that did not necessitate renal dialysis. Blood samples were collected from both category patients for serum creatinine prior to surgery, following surgery, on postoperative days 1, 2, 3, 4, 5, and on the day of discharge. The occurrence of acute kidney injury (AKI) was defined as an increase in the serum creatinine levels of ≥0.3 mg/dL within 48 hours or an increase of ≥1.5 above baseline known or presumed to have occurred within the previous 7 days based on Kidney Disease Improving Global Outcomes criteria. This study demonstrated that there was worsening of renal function in 7.4% of patients with normal renal function and 10.74% of patients with renal dysfunction that was not statistically different. Based on the results, we conclude that preoperative renal dysfunction may be a contributing predictor of AKI following OPCABG, and we recommend that the patients with more severe renal dysfunction with eGFR of 45–60 mL/min should be studied to demonstrate this hypothesis.

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