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In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children
M A Aziz1, A Z Hossain, T Banu
1Department of Surgery, BICH & Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh. draaziz@aitlbd.net
Summary
Preliminary nephrostomy improves kidney function in pediatric hydronephrosis, avoiding nephrectomy. This approach preserves renal function and prevents long-term complications associated with having a single kidney.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Hydronephrosis in children can lead to reduced kidney function.
- Nephrectomy is often considered for hydronephrotic kidneys with poor function.
- Preserving renal function in pediatric patients is crucial for long-term health.
Purpose of the Study:
- To reduce the incidence of nephrectomy in children with hydronephrosis.
- To evaluate the efficacy of preliminary nephrostomy in improving renal function.
- To avoid the long-term consequences of a single kidney in pediatric patients.
Main Methods:
- A study group of 12 pediatric patients with hydronephrosis and <10% renal function underwent DTPA renography.
- Initial treatment involved nephrostomy, followed by Anderson-Hynes pyeloplasty after 4-6 weeks.
- Postoperative assessments included renal ultrasound, urinalysis, blood urea, serum creatinine, DMSA scan, and DTPA renography.
Main Results:
- All 12 patients in the study group demonstrated improved renal function (>10%) after nephrostomy.
- Pyeloplasty was successfully performed in all patients within the planned timeframe.
- No significant pre-, peri-, or postoperative complications were observed.
Conclusions:
- Preliminary nephrostomy is a viable alternative to immediate nephrectomy for hydronephrotic kidneys with <10% function.
- This approach significantly improves renal functional status.
- It effectively avoids nephrectomy and the associated long-term risks of single-kidney status in children.