Does Diversion in Poorly Functioning Obstructed Kidneys in Adults Favors Reconstructive Surgeries Over Ablative...

Area of Science:

• Nephrology
• Urology
• Surgical Research

Background:

• Management of obstructed, poorly functioning kidneys hinges on their recovery potential.
• Kidney diversion may reveal underlying function, guiding treatment decisions.
• Pre-operative drainage is a potential strategy to assess and improve renal function.

Purpose of the Study:

• To evaluate the impact of six weeks of pre-operative percutaneous nephrostomy (PCN) drainage on renal function.
• To assess functional improvement in unilateral obstructed kidneys with split renal function (SRF) ≤20%.

Main Methods:

• Prospective interventional study involving 17 patients (15-65 years) with unilateral obstructed kidneys and SRF ≤20%.
• Patients underwent PCN drainage for six weeks.
• Selection for reconstructive surgery was based on post-drainage SRF ≥15% and urine output >400 ml/day; nephrectomy for SRF <15%.

Main Results:

• Twelve of 17 patients showed improved SRF after drainage; mean improvement in GFR and SRF was 1.4 ml/min and 3% (P=0.08).
• Three of seven patients with initial SRF ≥15% improved by ≥5%; none with SRF <15% showed similar improvement.
• Eight patients with final SRF <15% underwent nephrectomy; no pre-drainage factors predicted functional improvement.

Conclusions:

• Diversion and decompression do not significantly improve renal function in obstructed kidneys with SRF <15%.
• Pre-operative drainage is unlikely to restore function in severely compromised kidneys (SRF <15%).