MP27-11 SLOW DELIVERY RATE VERSUS RAPID DELIVERY RATE SHOCK WAVE LITHOTRIPSY (SWL) FOR PEDIATRIC RENAL UROLITHIASIS: A PROSPECTIVE RANDOMIZED STUDY

Abstract

INTRODUCTION AND OBJECTIVES: We aim at determining factors predicting recoverability of renal function after relief of obstruction with special emphasis on the method of drainage. METHODS: We retrospectively analyzed 137 adult patients with solitary kidneys presented with obstructive oliguria or anuria because of stone and/or stricture diseases and underwent temporal drainage by either PCN or JJ stents between January 2011 and June 2013. Patients< 18 years, or with obstruction because of malignancy or those underwent definitive intervention in the emergency setting were excluded. The primary outcome is the rate of decline of serum creatinine (SCr) after drainage of obstruction. The impact of method of drainage and other potential factors on the primary outcome were determined using univariate and multivariate analyses. RESULTS: A total of 127 patients showed a median (range) decline of SCr of 0.7 (0.05-2.7) mg/dl/day while 10 patients showed no change or rise of SCr and thereby excluded from the analysis. The rate of SCr decline showed non-significant association with gender, duration of obstruction, presence of diabetes mellitus or hypertension or the method of drainage. One the other hand, the rate of SCr decline showed significant correlation with SCr at presentation (r 1⁄4 0.4; p 1⁄4 0.001), urine culture (r 1⁄4 -0.262; p 1⁄4 0.005), fever after drainage (r 1⁄4 -0.225; p 1⁄4 0.017), baseline hemoglobin level (r 1⁄4 0.226; p 1⁄4 0.016) and number of previous episodes of obstructive uropathy (r 1⁄4 -0.251; p 1⁄4 0.007). On multivariate analysis, SCr at presentation (beta 1⁄4 0.308, p 1⁄4 0.001), hemoglobin level (beta 1⁄4 0.248, p 1⁄4 0.004), episodes of previous obstructive uropathy (beta 1⁄4 -0.198, p 1⁄4 0.019) and urine culture (beta 1⁄4 -0.198, p 1⁄4 0.02) were independent predictors of the rate of SCr decline. CONCLUSIONS: The method of temporal drainage of obstructive uropathy does not matter. Higher SCr and Hemoglobin levels at presentation are associated with rapid recovery of renal function while previous episodes of obstructive uropathy and positive urine culture slow down the recovery process.