Recoverability of renal function after relief of chronic partial upper urinary tract obstruction

Shokeir, Ahmed A.; Provoost, Abraham P.; Nijman, Rien J.M.

doi:10.1046/j.1464-410x.1999.00889.x

Cited by 51 publications

(33 citation statements)

References 45 publications

(74 reference statements)

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“…Tc-DTPA renal scintigraphy has been widely accepted as an indicator of nonsalvageable kidney. (6,10) In order to determine salvageability, the cutoff value for determining differential renal function has been accepted to be < 15%-20%. (3,11) Our study also found excellent specificity when a differential function of < 15% was used as the cutoff point to detect non-function of the kidney.…”

Section: Resultsmentioning

confidence: 99%

“…(8,9) Chronic obstructed kidney with renographic GFR < 10 mL/min/1.73 m 2 is widely accepted as nonsalvageable. (6,10) Meanwhile, the threshold of differential function at which irreversible loss of renal function should be considered is usually accepted as < 15%-20%. (3,11,12) However Tc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable.…”

Section: Introductionmentioning

confidence: 99%

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Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability?

Klaipetch¹,

Namwongprom²,

Ekmahachai³

et al. 2013

smedj

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RESULTSThe results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96).CONCLUSION Although most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability?

Klaipetch¹,

Namwongprom²,

Ekmahachai³

et al. 2013

smedj

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“…Patient age is one of the factors that was found to be related with recovery rate (20). The conclusion on the importance of patients' age for the recovery of UUO comes from the studies of the treatment of ureteropelvic junction obstruction, a congenital chronic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Deng et al (22) evaluated improvement of renal function in patients with ureteropelvic junction obstruction after insertion of nephrostomy and reported that paranchymal thickness increases in 4 weeks and tubular function returns to nearly normal levels in this period. In another study, Shokeir et al (20) evaluated renal resistive index and reported that at the first week of relief of obstruction, the mean resistive index significantly decreased and stabilized till to the 4 th week. According to these studies, we believe that a 4-week follow-up was enough to document recovery of renal functions after relief of obstruction.…”

Section: Discussionmentioning

confidence: 99%

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Yazıcı¹,

Tavukçu²,

Tınay³

et al. 2016

jus

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What's known on the subject? and What does the study add? ÖZ AmaçÇalışmamızda akut/subakut tek taraflı komplet üreteral tıkanıklığa bağlı böbrek fonksiyonlarının nefrostomi ile tedavi sonrası değişimini göstermek amaçlanmıştır. gereç ve yöntemOtuz hasta prostpektif olarak çalışmaya dahil edilmiştir. Hepsinin üreter taşı olup 24'ünde (%80) üst üreter ve 6'sında (%20) orta üreter yerleşimliydi. Tüm hastaların ileri düzeyde hidronefrozu olduğu için perkütan nefrostomi takılması planlandı. Nefrostomi takıldıktan sonra 1. haftada etkilenen böbrek nefrostomiden ve diğer böbrek üretral kreatinin klirensi ölçümü ile değerlendirilmiştir. Değişikliği saptamak için de 1. ayda nefrostomi ve üretral kreatinin klirensleri hesaplanıp 1. haftadaki sonuçlar ile karşılaştırılmıştır. BulgularHastalarımızın ortalama yaşı 44,6'dır (36-54). Etkilenen böbreğin 1. haftadaki kreatinin klirensi 38,8±4,9 ml/dak iken 1. aydaki değer 42,5±5,4 ml/dk'ya yükselmiştir (p<0,001). Tüm hastaların kreatini klirens analizlerinde %2,3 ile %17,3 arasında artış saptanmıştır. SonuçÇalışma sonuçlarımıza göre tek taraflı komplet üreteral tıkanıklığa bağlı bozulan böbrek fonksiyonu nefrostomi takılması sonrası 1. ayda 1. haftaya göre anlamlı olarak düzelmektedir. Bu düzelme böbrek fonksiyonları sınırda olan tek taraflı tıkanıklığı olan hastalarda asıl tedaviye veya nefrektomi yapmaya karar vermede etkili olacaktır. Anahtar KelimelerKreatinin klirens, nefrostomi, obstrüktif üropati objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and MethodsThirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. ResultsThe mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8±4.9 ml/min in the first week of urinary diversion and increased to 42.5±5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5±4.7%. ConclusionAccording to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidney KeywordsCreatinine clearance, nephrostomy, obstructive uropathy This is first study that evaluated the renal function change after relief of unilateral ureteral obstruction because of ureteral stones.

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“…After stabilising the patient's condition, a renal radio-isotopic scan using 99m Tc À MAG3 was taken to estimate the differential function of the affected kidney. Preservation of the affected kidney was attempted when the differential function was >10% [13].…”

Section: Methodsmentioning

confidence: 99%

194 Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up

El-Nahas¹,

Shokeir²,

Barakat³

et al. 2012

European Urology Supplements

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Recoverability of renal function after relief of chronic partial upper urinary tract obstruction

Cited by 51 publications

References 45 publications

Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability?

Excretory urography and renal scintigraphy for chronic obstructed kidney: does nonopacity mean nonsalvageability?

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

194 Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up

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