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Factors predicting improvement of differential renal function after pyeloplasty in children of ureteropelvic junction obstruction

  • Yi Li
    Affiliations
    Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Yuzhu He
    Affiliations
    Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Weiping Zhang
    Correspondence
    Correspondence to: Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China, Tel.: +13370115012
    Affiliations
    Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Hongcheng Song
    Affiliations
    Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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  • Tianyi Wang
    Affiliations
    Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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      Summary

      Introduction

      To evaluate differential renal function (DRF) in unilateral ureteropelvic junction obstruction (UPJO) patients under 18 years old after pyeloplasty and to identify factors predicting postoperative improvement.

      Material and methods

      A total of 95 patients with unilateral UPJO treated by pyeloplasty between March 2019 to March 2020 were prospective enrolled. All patients had preoperative dynamic renal scintigraphy and were required to review after surgery 6 months. We defined DRF improvement as postoperative DRF increased ≥5% (If preoperative DRF less than 55%) or postoperative DRF reduced ≥5% and reached a normal range (45–55%) (preoperative DRF more than 55%) with drainage improvement. Drainage improvement indications were defined as a resolution of symptoms; decrease in hydronephrosis without requiring additional procedures and T1/2<20min in dynamic renal scintigraphy. All parameters were statistically compared.

      Results

      In the study, 28 (29.5%) patients showed improvement in postoperative DRF, and 67 (70.5%) patients maintained stable postoperative DRF. Gender, age, baseline DRF, anteroposterior pelvic diameters (APD), minimum and maximum renal parenchymal thickness (PT), and anterior-posterior diameter/maximum renal parenchymal thickness (APD/PT) were correlated with postoperative DRF improvement in univariable analysis. In the multivariable analyses, maximum PT and APD/PT were predictors of improvement in postoperative DRF.

      Discussion

      In our study, the maximum PT was associated with the improvement of renal function in patients with UPJO, and when the thickest part of the renal parenchyma was measured, APD/PT can predict the improvement of renal function. We infer that the compression of the thickest part of the renal parenchyma may be the reason for the impaired renal function in some patients, and when the obstruction was relieved, the compressed parenchyma function can be significantly improved.

      Conclusions

      TableCharacteristics and preoperative data of 95 children with UPJO, grouped by improvement of DRF
      Variable DRF χ2/z p
      Improved(n = 28) No improved (n = 67)
      Gender
       Male 26 49 4.622 0.032
       Female 2 18
      Side
       Left 22 49 0.309 0.578
       Right 6 18
      Diagnosis time
       Prenatal 14 32 0.040 0.842
       Postnatal 14 35
      Age(y)
       <1 11 11 5.803 0.016
       ≥1 17 56
      Surgical approach
       OP 11 15 2.837 0.092
       LP 17 52
      Baseline DRF
       <40% 11 12 5.739 0.044
       40%–55% 14 50
       ≥55% 3 5
      APD (cm) 3.9(2.5,6.1) 2.8(2.2,3.6) −2.779 0.005
      Minimum PT (cm) 0.2(0.8,0.5) 0.3(0.2,0.5) −1.44 0.153
      Maximum PT (cm) 0.6(0.4,0.9) 0.8(0.6,1) −2.448 0.014
      APD/PT 6.8(3.3,12.4) 3.5(2.3,5.3) −2.977 0.003

      Keywords

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      References

        • Tabari A
        • Atqiaee K
        • Mohajerzadeh L
        • Rouzrokh M
        • Ghoroubi J
        • Alam A
        • et al.
        Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants.
        J Pediatr Surg. 2020; 55: 1936-1940https://doi.org/10.1016/j.jpedsurg.2019.08.006
        • Nordenström J
        • Koutozi G
        • Holmdahl G
        • Abrahamsson K
        • Sixt R
        • Sjöström S
        • et al.
        Changes in differential renal function after pyeloplasty in infants and children.
        J Pediatr Urol. 2020; 16: 329.e1-329.e8https://doi.org/10.1016/j.jpurol.2020.02.002
        • Jiang D
        • Tang B
        • Xu M
        • Lin H
        • Jin L
        • He L
        • et al.
        Functional and morphological outcomes of pyeloplasty at different ages in prenatally diagnosed society of fetal urology grades 3-4 ureteropelvic junction obstruction: is it safe to wait?.
        Urology. 2017; 101: 45-49https://doi.org/10.1016/j.urology.2016.10.004
        • Harraz A.M
        • Helmy T
        • Taha D.E
        • Shalaby I
        • Sarhan O
        • Dawaba M
        • et al.
        Changes in differential renal function after pyeloplasty in children.
        J Urol. 2013; 190: 1468-1473https://doi.org/10.1016/j.juro.2013.01.004
        • Bowen D
        • Mittal S
        • Aghababian A
        • Eftekharzadeh S
        • Dinardo L
        • Weaver J
        • et al.
        Pyeloplasty is a safe and effective surgical approach for low functioning kidneys with ureteropelvic junction obstruction.
        J Pediatr Urol. 2021; 17: 233.e1-233.e7https://doi.org/10.1016/j.jpurol.2020.12.018
        • Rickard M
        • Braga L
        • Gandhi S
        • Oliveria J
        • Demaria J
        • Lorenzo A
        Comparative outcome analysis of children who underwent pyeloplasty for ureteropelvic junction obstruction associated with or without supranormal differential renal function.
        Urology. 2017; 99: 210-214https://doi.org/10.1016/j.urology.2016.07.016
        • Martín-Solé O
        • Soria-Gondek A
        • Pérez-Bertólez S
        • Paredes P
        • Tarrado X
        • García-Aparicio L
        Value of supranormal function on Tc-mercaptoacetyltriglycine renal scan in paediatric patients with obstructive hydronephrosis.
        BJU Int. 2019; 124: 842-848https://doi.org/10.1111/bju.14781
        • Gordon I
        • Piepsz A
        • Sixt R
        Guidelines for standard and diuretic renogram in children.
        Eur J Nucl Med Mol Imag. 2011; 38: 1175-1188https://doi.org/10.1007/s00259-011-1811-3
        • Romao R
        • Farhat W
        • Pippi Salle J
        • Braga L
        • Figueroa V
        • Bägli D
        • et al.
        Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction.
        J Urol. 2012; 188: 2347-2353https://doi.org/10.1016/j.juro.2012.08.036
        • Rickard M
        • Braga L
        • Oliveria J
        • Romao R
        • Demaria J
        • Lorenzo A
        Percent improvement in renal pelvis antero-posterior diameter (PI-APD): prospective validation and further exploration of cut-off values that predict success after pediatric pyeloplasty supporting safe monitoring with ultrasound alone.
        J Pediatr Urol. 2016; 12 (228.e1-6)https://doi.org/10.1016/j.jpurol.2016.04.003
        • Chipde S
        • Lal H
        • Gambhir S
        • Kumar J
        • Srivastava A
        • Kapoor R
        • et al.
        Factors predicting improvement of renal function after pyeloplasty in pediatric patients: a prospective study.
        J Urol. 2012; 188: 262-265https://doi.org/10.1016/j.juro.2012.03.023
        • O’Reilly P
        • Brooman P
        • Mak S
        • Jones M
        • Pickup C
        • Atkinson C
        • et al.
        The long-term results of Anderson-Hynes pyeloplasty.
        BJU Int. 2001; 87: 287-289https://doi.org/10.1046/j.1464-410x.2001.00108.x
        • Chandrasekharam V
        • Srinivas M
        • Bal C
        • Gupta A
        • Agarwala S
        • Mitra D
        • et al.
        Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis.
        Pediatr Surg Int. 2001; 17: 524-527https://doi.org/10.1007/s003830100604
        • Boubaker A
        • Prior J
        • Meyrat B
        • Bischof Delaloye A
        • McAleer I
        • Frey P
        Unilateral ureteropelvic junction obstruction in children: long-term followup after unilateral pyeloplasty.
        J Urol. 2003; 170 (discussion 579): 575-579https://doi.org/10.1097/01.ju.0000071480.83890.36
        • Shokeir A
        • El-Sherbiny M
        • Gad H
        • Dawaba M
        • Hafez A
        • Taha M
        • et al.
        Postnatal unilateral pelviureteral junction obstruction: impact of pyeloplasty and conservative management on renal function.
        Urology. 2005; 65 (discussion 985): 980-985https://doi.org/10.1016/j.urology.2004.12.065
        • Babu R
        • Rathish V
        • Sai V
        Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction.
        J Pediatr Urol. 2015; 11https://doi.org/10.1016/j.jpurol.2014.10.007
        • Onen A.
        Grading of hydronephrosis: an ongoing challenge.
        Frontiers in pediatrics. 2020; 8: 458https://doi.org/10.3389/fped.2020.00458
        • Moghazi S
        • Jones E
        • Schroepple J
        • Arya K
        • McClellan W
        • Hennigar R
        • et al.
        Correlation of renal histopathology with sonographic findings.
        Kidney Int. 2005; 67: 1515-1520https://doi.org/10.1111/j.1523-1755.2005.00230.x
        • Konda R
        • Sakai K
        • Ota S
        • Abe Y
        • Hatakeyama T
        • Orikasa S
        Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99m technetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty.
        J Urol. 2002; 167: 2159-2163https://doi.org/10.1097/00005392-200205000-00061
        • Lama G
        • Ferraraccio F
        • Iaccarino F
        • Luongo I
        • Marte A
        • Rambaldi P
        • et al.
        Pelviureteral junction obstruction: correlation of renal cell apoptosis and differential renal function.
        J Urol. 2003; 169: 2335-2338https://doi.org/10.1097/01.ju.0000067385.26560.7c
        • Xu G
        • Xu M
        • Ma J
        • Chen Z
        • Jiang D
        • Hong Z
        • et al.
        An initial differential renal function between 35% and 40% has greater probability of leading to normal after pyeloplasty in patients with unilateral pelvic-ureteric junction obstruction.
        Int Urol Nephrol. 2017; 49: 1701-1706https://doi.org/10.1007/s11255-017-1665-0
        • Roth D.R.
        • Gonzales Jr., E.T.
        Management of ureteropelvic junction obstruction in infants.
        J Urol. 1983; 129: 108-110https://doi.org/10.1016/s0022-5347(17)51945-x
        • Gopal M
        • Peycelon M
        • Caldamone A
        • Chrzan R
        • El-Ghoneimi A
        • Olsen H
        • et al.
        Management of ureteropelvic junction obstruction in children-a roundtable discussion.
        J Pediatr Urol. 2019; 15: 322-329https://doi.org/10.1016/j.jpurol.2019.05.010
        • Pippi Salle J
        • Cook A
        • Papanikolaou F
        • Bägli D
        • Breen S
        • Charron M
        • et al.
        The importance of obtaining conjugate views on renographic evaluation of large hydronephrotic kidneys: an in vitro and ex vivo analysis.
        J Urol. 2008; 180: 1559-1565https://doi.org/10.1016/j.juro.2008.06.010
        • Pavlaki A
        • Farmaki E
        • Papachristou F
        • Printza N
        Letter to the editor regarding ‘changes in differential renal function after pyeloplasty in infants and children’ by Josefin Nordenström, Giasemi Koutozi, Gundela Holmdahl, kate Abrahamsson, Rune Sixt, Sofia Sjöström.
        J Pediatr Urol. 2020; 16: 740-741https://doi.org/10.1016/j.jpurol.2020.07.033