Kalra Sidhartha, Mehra Ketan, Muruganandham Kaliyaperumal, Dorairajan Lalgudi N, Manikandan Ramanitharan, Dhanapathi Halanaik, Sreenivasan Kodakkattil Sreerag
Urology and Renal Transplantation, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND.
Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, IND.
Cureus. 2020 Aug 29;12(8):e10124. doi: 10.7759/cureus.10124.
Objective In obstructed poorly functioning kidneys, management depends on the recovery potential of the kidney. Some kidneys have good recovery capability and diversion may unfold the real condition of the kidney. This study evaluated whether pre-operative drainage for six weeks results in improvement of renal function in unilateral obstructed poorly functioning kidney with split renal function (SRF) less than 20%. Methods This was a prospective interventional study conducted between March 2013 and December 2015. All patients between 15 and 65 years, with unilaterally obstructed kidney with SRF ≤20% underwent percutaneous nephrostomy (PCN) drainage for six weeks. Patients having post-drainage SRF of ≥15% and per day urine output from PCN > 400 ml were considered for the reconstructive procedure. Nephrectomy was performed in cases with SRF <15% after considering patient preferences. Results Twelve of 17 patients had improvement in SRF; four had no change while one had a decrease in SRF after drainage. The mean improvement in glomerular filtration rate (GFR) and SRF was 1.4 ml/min and 3%, respectively (P = 0.08). Three out of seven patients with SRF of ≥15% showed an improvement of 5% or more while none of the patients with SRF <15% had such an improvement. Eight patients had final SRF <15% and underwent nephrectomy. Factors such as pre-existing SRF, duration of symptoms, kidney size, transverse pelvic diameter, 24-hour urinary output, and etiology for obstruction were not significant in predicting functional improvement. Conclusion Diversion and decompression of poorly functioning kidneys do not result in a significant functional improvement in obstructed kidneys with SRF <15%.
目的 在梗阻性肾功能不良的肾脏中，治疗方案取决于肾脏的恢复潜力。有些肾脏具有良好的恢复能力，而引流可能会展现出肾脏的真实状况。本研究评估了术前六周引流是否能改善单侧梗阻性肾功能不良且分肾功能（SRF）低于20%的肾脏的肾功能。方法 这是一项于2013年3月至2015年12月进行的前瞻性干预研究。所有年龄在15至65岁之间、单侧肾脏梗阻且SRF≤20%的患者接受了为期六周的经皮肾造瘘（PCN）引流。引流后SRF≥15%且PCN每日尿量>400 ml的患者被考虑进行重建手术。在考虑患者意愿后，对SRF<15%的患者进行了肾切除术。结果 17例患者中有12例SRF有所改善；4例无变化，1例引流后SRF下降。肾小球滤过率（GFR）和SRF的平均改善分别为1.4 ml/min和3%（P = 0.08）。7例SRF≥15%的患者中有3例改善了5%或更多，而SRF<15%的患者中无一例有如此改善。8例患者最终SRF<15%并接受了肾切除术。诸如术前SRF、症状持续时间、肾脏大小、盆腔横径、24小时尿量以及梗阻病因等因素在预测功能改善方面并无显著意义。结论 对SRF<15%的梗阻性肾功能不良的肾脏进行引流和减压并不能显著改善其功能。
