Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Medicine, Uniformed Services University, Bethesda, MD, USA.
Int Urol Nephrol. 2024 Oct;56(10):3209-3216. doi: 10.1007/s11255-024-04075-9. Epub 2024 May 11.
To evaluate the impact of surgical intervention on long-term renal outcomes for adult patients with congenital ureteropelvic junction obstruction (UPJO).
We queried service members diagnosed with UPJO from the United States Military Health System electronic health records from 2005 to 2020. We assessed demographic, laboratory, radiology, surgical intervention, and outcome data. We evaluated the impact of surgical intervention on renal function based on the estimated glomerular filtration rate (eGFR), hypertension (HTN, defined as any prescription for blood pressure [BP] medication and/or average of two BP readings ≥ 130/80 mmHg more than 2 weeks apart), and changes in renal excretory function on radionuclide scans.
We identified 108 individuals diagnosed with congenital UPJO; mean follow-up of 7 years. Mean age at diagnosis was 25 years; 95% male; 69% White, 15% Black. At diagnosis, median BP was 130/78 mmHg and mean eGFR 93 ml/min/1.73m. Subsequently, 85% had pyeloplasty and 23% had stent placement. There were no significant differences in mean eGFR pre- and post-intervention (94 vs. 93 ml/min/1.73m, respectively; p = 0.15) and prevalence of defined HTN (59% vs. 61%, respectively; p = 0.20). Surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p = 0.01) and T½ emptying time (35 min vs. 19 min, p = 0.009). Similar trends occurred with left-sided UPJO but were not significant.
Surgical intervention was not associated with significant differences in the long-term outcomes of kidney function and HTN prevalence in our young adult cohort. However, renal excretory function improved on radionuclide scans.
评估手术干预对成人先天性肾盂输尿管连接部梗阻（UPJO）患者长期肾脏结局的影响。
我们在美国军事医疗系统电子健康记录中查询了 2005 年至 2020 年期间被诊断为 UPJO 的军人。我们评估了人口统计学、实验室、影像学、手术干预和结局数据。我们根据肾小球滤过率（eGFR）、高血压（HTN，定义为任何血压（BP）药物处方和/或两次 BP 读数平均值 ≥ 130/80mmHg 超过 2 周）和核素扫描上肾脏排泄功能的变化评估手术干预对肾功能的影响。
我们确定了 108 名被诊断为先天性 UPJO 的患者；中位随访时间为 7 年。诊断时的平均年龄为 25 岁；95%为男性；69%为白人，15%为黑人。诊断时，中位血压为 130/78mmHg，平均 eGFR 为 93ml/min/1.73m。随后，85%的患者接受了肾盂成形术，23%的患者接受了支架置入术。干预前后平均 eGFR 无显著差异（分别为 94 和 93ml/min/1.73m，p=0.15），定义性高血压的患病率也无显著差异（分别为 59%和 61%，p=0.20）。右侧 UPJO 的手术干预显著降低了皮质排泄延迟的患者比例（术前为 54%，术后为 35%，p=0.01）和 T½排空时间（35 分钟 vs. 19 分钟，p=0.009）。左侧 UPJO 也出现了类似的趋势，但无统计学意义。
在我们的年轻成人队列中，手术干预与肾功能和 HTN 患病率的长期结局无显著差异。然而，核素扫描显示肾脏排泄功能有所改善。
