Abstract
ObjectiveIn 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%.MethodsThis 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.ResultsTwelve 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.ConclusionDiversion and decompression of poorly functioning kidneys do not result in a significant functional improvement in obstructed kidneys with SRF <15%.
Highlights
Functioning obstructed kidney in adults is a common problem encountered by the urologist
Three out of seven patients with split renal function (SRF) of ≥15% showed an improvement of 5% or more while none of the patients with SRF
The results showed that percutaneous nephrostomy (PCN) drainage did not result in a significant functional improvement and clinical outcome in obstructed kidneys with SRF ≤15%
Summary
Functioning obstructed kidney in adults is a common problem encountered by the urologist. Surgical management of these kidneys is usually based on the differential renal function calculated on the diuretic renogram [1]. It is recommended to reassess the function of these kidneys at four to six weeks after the relief of obstruction. This recommendation is based on an animal study conducted by Kerr in 1954 [2]. Few reports consider that there is a functional recovery after drainage while others are of the view that there is no chance of improvement of function in poorly functioning obstructed kidneys
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