Can pyeloplasty restore normal renal function in patients with severe unilateral ureteropelvic junction obstruction and DRF<35%


Tarek Ahmed Mahmoud*, Esam El din Salem Morsy, Hany Abd Elraoof Ali Morsy, Abdelmoneim Mohammed Abouzeid, Ahmed Mamdouh Abd Elhamed, Elnisr Rashed Mohamed and Hazem Mohamed Elmoghazy

Purpose: To assess the outcome of successful pyeloplasty in infants with ureteropelvic junction obstruction and Differential Renal Function (DRF)<35% to determine whether they can attain normal postoperative renal function or not.

Methods: All children diagnosed with antenatal hydronephrosis due to UPJO presented to our institutions were prospectively followed up. Pyeloplasty was performed based on predefined indications such as initial DRF ≤ 40%, progression of hydronephrosis, and recurrent UTI. A total of 173 children who had successful surgical intervention due to impaired DFR, were divided according to their pre intervention DRF value as follows: DRF<35% (group I) and DRF 35-40% (group II). The renal morphology and function changes were recorded and used for comparison between both groups.

Results: Group I comprised 79 patients, and group II included 94 patients. Pyeloplasty achieved significant improvement in the anatomical and functional indices in both groups (p-value<0.001). The degree of improvement in APD and cortical thickness was comparable in both groups (P-value, 0.64 and 0.44 respectively). While the improvement in the DRF was significantly higher in group I (16.06 ± 6.6) than in group II (6.25 ± 2.66), (P-value<0.001). Despite that, a significantly higher percentage of infants in group II (61.7%) achieved normal final DRF compared with only (10.1%) in group I (P-value<0.001).

Conclusion: Even in badly affected renal function (<35%) pyeloplasty can recover a significant part of lost renal function, however, most of those patients do not achieve normal postoperative renal function.

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