Does baseline renal function always decrease after unilateral ureteral severe obstruction? -experimental validation and novel findings by Tc-99m diethylene triamine pentaacetate acid (DTPA) dynamic renal scintigraphy.

Abstract

There is a lack of consensus concerning changes in renal function after unilateral ureteral obstruction. The aim of this study was to assess the influence of ureteral obstruction on renal morphology and function and to explore the effectiveness of dynamic renal scintigraphy in evaluating obstructive renal function. We established a model of right ureteral obstruction using New Zealand white rabbits. We measured the glomerular filtration rate (GFR) before the operation and from days 1 to 82 after obstruction, observed the changes in bilateral kidney sizes and the GFR, and then compared the differences between the left and right kidneys. The difference between left and right kidney sizes was not significant before obstruction (t=-0.430, P=0.674); the right kidneys increased in size after obstruction and were larger than the left kidneys (P≤0.001). Obstructed kidneys demonstrated a morphological process of decelerated expansion and retraction. The difference in GFR between the left and right kidneys was not significant before obstruction (t=1.77, P=0.098); during days 1-21 and 42-82 after obstruction, the GFR of the right kidneys decreased and was lower than that of the left kidneys (P<0.001); on day 28, the GFR difference between the left and right kidneys (t=1.62, P=0.130) and the difference in the right kidney GFR before and after obstruction (t=1.03, P=0.323) were not significant. The GFR of obstructed kidneys rapidly declined initially, experienced a tortuous process of repeated dormancies and multiple self-recoveries, and then gradually declined. The GFR in hydronephrotic kidneys is fluctuating. Thus, evaluating the true function of hydronephrotic kidneys using only baseline GFR is difficult; however, combining baseline GFR with renal morphology to assess obstructive renal function and its recoverability can provide more meaningful results.