Summary
Introduction and objectives
The management of bilateral ureteropelvic junction obstruction (UPJO) is greatly debated.
We aim to identify the risk of early postoperative acute kidney injury (AKI) in relation
to the sequence of intervention in children with bilateral UPJO managed in a sequential
manner.
Methods
A single center database was retrospectively reviewed for children ≤2 years who underwent
bilateral pyeloplasty. According to the differential renal function on the preoperative
renograms, patients were categorized into group A: pyeloplasty on the poorer functioning kidney first and group B: pyeloplasty on the better functioning side first. Serum creatinine and eGFR, using
the modified Schwartz formula, were evaluated at four time points (I): before the
first intervention (II): within 48 h of the first intervention (III): before the second
intervention and (IV): within 48 h of the second intervention. Preoperative and postoperative
values were compared. The incidence of early postoperative AKI in both groups was
defined according to the Acute Kidney Injury Network (AKIN) criteria.
Results
The study comprised 46 children treated by staged pyeloplasty, 28 of them underwent
pyeloplasty on the poorer functioning side first. Baseline serum creatinine and eGFR
were not significantly different between both groups. Patients who underwent pyeloplasty
on the poorer functioning side first, had a significant decline of eGFR after the
first intervention (p = 0.006). Conversely, no significant eGFR changes were observed
after the first or second interventions in the other group (figure). Overall, 64.3%
and 33.3% of patients developed some degrees of AKI when intervention was started
on the poorer and better functioning renal units, respectively (p = 0.04).
Discussion
Bilaterality is seen in approximately ¼ of patients with UPJO. Oftentimes, both renal
units are asymmetrically affected with little data to guide surgeons on the optimal
sequence of intervention. Following pyeloplasty, 52.2% of the evaluated children with
bilateral UPJO had early postoperative AKI, mostly of low stage. Our data suggest
that intervening first on the better functioning side allows for better recovery of
the renal functional reserve and lowers the risk of postoperative AKI.
Conclusion
Graphical AbstracteGFR changes in both study groups (group A: intervention first on the poorer functioning
renal unit, group B: intervention first on the better functioning renal unit), Y-axis
shows eGFR values in ml/min/1.73m2, X-axis shows points of evaluation throughout the study: Pre-op (1): before the first
intervention, Post-op (1): within 48 h of the first intervention, Pre-op (2): before
the second intervention, Post-op (2): within 48 h of the second intervention.
Keywords
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Article info
Publication history
Published online: August 16, 2022
Accepted:
August 8,
2022
Received in revised form:
July 30,
2022
Received:
February 6,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
