Factors predicting renal recoverability after percutaneous nephrostomy in obstructive uropathy
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2016, Vol 4, Issue 9
Abstract
Obstructive uropathy is one of the commonest urological emergencies. The accurate prediction of the recoverability of kidney function after the release of obstruction is of great clinical value to the urologist. The objective is to evaluate the role of percutaneous nephrostomy in relieving obstruction and improvement of kidney function in patients with obstructive uropathy &various predictive factors to assess recoverability of kidney function in seventy two patients of upper tract obstruction for various causes who needed percutaneous nephrostomy. Following admission all patients of the study population underwent complete urine analysis, urine culture and sensitivity, serum creatinine, and complete blood count, followed by ultrasonography Abdominal ultrasonography (US) was carried out in all patients with special interest to renal size, parenchymal thickness and degree of hydronephrosis. Glomerular filtration rate (GFR) was calculated in these study subjects using the “modification of diet in renal disease” (MDRD) formula. Following percutaneous nephrostomy (PCN) GFR & Serum creatinine was recorded on day1, day3, day7, and day 28& at the end of 3rd month .In our study, serum creatinine level < 1.5 and GFR> 60 was taken as recoverable group. Correlation of continuous and categorical variables with dependent variable (Post op Serum Creatinine level & Post Op GFR after 3 months) was formulated using spearman correlation and Mann–Whitney U test. Multiple linear regression analysis was performed. The study population includes 72 patients with mean age of 44.65years in male 38 (52.8%) and female 34(47.2%). In our study renal and ureteric stone is the commonest (29.17%) cause of obstructive uropathy. Co morbidities like diabetes and hypertension were present in 42 and urinary infection in 14 patients. Co morbidities &presence of infection significantly affecting the renal function recoverability having p value 0.032& 0.049 respectively. There was a significant decline in the mean creatinine level with gross improvement in urine output at each successive follow ups which was statistically significant (P<0.05).Multiple Regression result suggest with 1 unit change of Pre PCN GFR, cortical thickness(CT),hemoglobin(Hb), creatinine at 3 months post PCN changes significantly.(p<0.05) A correlation was plotted between the resistive index (RI) and serum creatinine values before drainage and at the different points after drainage and it showed a good positive result (R=0.334,P<0.05).However RI &other variables like degree of hydronephrosis, time interval between disease onset & intervention lost their statistical significance in predicting renal function recoverability. Percutaneous nephrostomy is a procedure that has significant implications for the treatment of obstruction in the kidneys. Thus, significant predictors like renal CT, Pre Rx GFR, Pre Rx urine output, Hb, renal size can provide an index to evaluate residual renal function so that the procedure is done in time to prevent further ongoing damage. Keywords: Creatinine level, cortical thickness, obstructive uropathy, resistive index, renal size.
Authors and Affiliations
Dr. Surajit Sasmol, Dr. Bastab Ghosh, Manju Banerjee, Dilip Kumar Pal
Keywords
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