Predictive factor of renal function recoverability in upper-tract obstructive uropathy after percutaneous nephrostomy and Double -J stent insertion in Indonesian National Referral Hospital

Abstract

Introduction: Obstructive uropathy (OU) is defined as an alteration in any level of the urinary tract that is caused by abnormalities of its system organs, or external pathological factors. Hydronephrosis and progressive renal impairment are signs of upper-tract OU. OU accounted to be around 0,9% - 3,8% of prevalence for etiology of hydronephrosis. The aim of OU treatment is to achieve optimal urinary diversion, either by retrograde intra-ureteral stenting or percutaneous drainage. However, improvement of renal function after urinary diversion is not always evident. The purpose of this study was to identify predictive factors of improvement in renal function following ureteral stent insertion or percutaneous nephrostomy in OU cases. Methods: This was a retrospective, single-center study on patients with OU, who underwent ureteral stenting with Double J (DJ) stent or percutaneous nephrostomy. Several commonly measured clinical indices were documented, including preoperative haemoglobin, Ht, leucocyte, thrombocyte, serum creatinine, blood urea, electrolyte, blood urea to serum creatinine ratio, and renal parenchymal thickness. We focused on finding which parameters correlated with postsurgical decrease in serum creatinine level. Result: We evaluate 567 patients that underwent DJ stent insertion and percutaneous nephrostomy. There was a statistically significant relationship between parenchymal thickness with post-operative creatinine serum decrease, with an OR of 11.24 (p<0.01, CI 7,5 – 16,8). Another parameter that has a statistically significant relationship with successful operative outcomes was blood urea to serum creatinine with OR = 27,9 (p-value < 0.01, 95% CI 17,4 – 44,8. Other laboratory factors had no statistical significance in predicting renal function recoverability. Conclusion: There was a statistically significant relationship between renal parenchymal thickness and blood urea-creatinine ratio with a favourable operational outcome in OU, as evidenced by a reduction in postoperative creatinine serum level.

The Comparison of Clinical Outcomes Between DJ Stent Insertion and Percutaneous Nephrostomy in Patients with Obstructive Uropathy due to Cervical Cancer

“…This study shows no significant difference between kidney function in nephrostomy and DJ stent postoperatively. Some study shows the same result [2,3]. Meanwhile, Shoshany et al (2015) found that renal function improvement was better after Double-J stent than percutaneous nephrostomy In their study, eGFR after DJ Stent insertion and nephrostomy is 85.5 (69.3-90.6) MDRD, mL/min/1.73 m2 vs. 69 (58.1-80.4) MDRD, mL/min/1.73 m2, a p-value of 0.001 This difference is because patients who undergo nephrostomy have a lower baseline eGFR before the procedure, and renal function tests are carried out over more extended periods [4].…”