Improvement of renal split function in hydronephrosis with less than 10 % function.

Area of Science:

• Pediatric Urology
• Nephrology

Background:

• Severe hydronephrosis can lead to decreased kidney split function (SF), often necessitating surgical intervention.
• Current practice often bases the decision between pyeloplasty and nephrectomy on SF, with <10% typically indicating nephrectomy.

Purpose of the Study:

• To evaluate the efficacy of pyeloplasty in improving SF in children with severe hydronephrosis, particularly those with initial SF <10%.

Main Methods:

• Retrospective analysis of 32 children with severe hydronephrosis undergoing Anderson-Hynes pyeloplasty (AHP).
• Patients were grouped by initial SF: >40%, 10-40%, and <10%.
• Postoperative follow-up included renal ultrasonography and MAG3-diuretic nephrography (DNG) at 12 months.

Main Results:

• In patients with initial SF <10%, postoperative SF significantly improved, reaching 21-53% at follow-up.
• Overall, postoperative DNG showed a significant improvement in average SF from 41% preoperatively to 47% postoperatively.
• All patients demonstrated improved SF after AHP, regardless of initial function.

Conclusions:

• Pyeloplasty is effective in improving renal function in children with hydronephrosis, even with severely impaired initial SF (<10%).
• The study supports performing pyeloplasty in these cases, challenging the routine indication for nephrectomy based solely on low initial SF.