Factors Predicting Improvement of Renal Function After Pyeloplasty in Pediatric Patients: A Prospective Study

Chipde, Saurabh Sudhir; Lal, Hira; Gambhir, Sanjay; Kumar, Jitendra; Srivastava, Aneesh; Kapoor, Rakesh; Ansari, M.S.

doi:10.1016/j.juro.2012.03.023

Cited by 19 publications

(12 citation statements)

References 15 publications

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“…In the present study, large APD and thin PT during non-pain periods are associated with impaired renal function in patients with hydronephrosis and abdominal pain, which is consistent with previous studies in asymptomatic UPJO patients [12][13][14]. Acute pain attacks have been shown to be linked to worsening DRF.…”

Section: Apd and Ptsupporting

confidence: 92%

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

et al. 2023

Preprint

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Objective This study aimed to investigate whether ultrasound parameters during non-painful episodes could indicate impaired differential renal function (DRF) in patients with ureteropelvic junction obstruction (UPJO) and intermittent abdominal pain. Methods We conducted a retrospective review of all cases of unilateral UPJO with intermittent abdominal pain undergoing their first pyeloplasty between March 2019 and October 2021. Clinical characteristics, such as gender, affected side, age at the first onset of pain, waiting time for pyeloplasty, age, and concurrent symptoms, were collected. Ultrasound examination (US) was used to measure the anteroposterior diameter (APD) and renal parenchyma thickness (PT) during intermittent pain episodes and dynamic renal scintigraphy (RDS) was used to assess DRF. Results This study investigated the characteristics and demographics of 109 patients with UPJO. Of the patients, 28.4% had baseline DRF less than 40%, and factors affecting baseline DRF were analyzed. Patients diagnosed with hydronephrosis before the onset of pain had a lower risk of DRF impairment compared to those diagnosed after the onset of pain (p = 0.021). Patients with impaired renal function had larger APD and thinner PT values on ultrasound (p = 0.002, p༜0.001). Abdominal pain accompanying symptoms were found to be associated with DRF impairment (p = 0.044). Multifactorial analysis identified that right UPJO, diagnosis of UPJO after pain onset, large APD, and thin PT were risk factors for baseline DRF damage in patients with intermittent abdominal pain (p༜0.05). Conclusion Patients with right-sided UPJO, UPJO diagnosed after a pain episode, and those with larger APD and thinner PT on ultrasound during pain-free intervals were more likely to have DRF impairment.

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Section: Apd and Ptsupporting

confidence: 92%

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

et al. 2023

Preprint

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“…Previous reports stated that percent improvement in anteroposterior diameter and postoperative pelvic anteroposterior diameter measurements can predict success after pyeloplasty [4]. Chipde et al [19 ]confirmed that pelvic anteroposterior diameter and PCR can be useful parameters for the prediction of successful intervention. …”

Section: Discussionmentioning

confidence: 97%

Can Renal Ultrasonography Predict Early Success after Pyeloplasty in Children? A Prospective Study

Helmy¹,

Harraz²,

Sharaf

et al. 2014

Urol Int

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Objective: To study the predictive value of 6 ultrasonographic (USG) parameters for early detection of children at risk of recurrent obstruction. Patients and Methods: A prospective nonrandomized study included all patients who underwent pyeloplasty between 2010 and 2012. All of the patients had completed at least 6 months of follow-up and preoperative and postoperative USG imaging data were available. The primary outcome was the correlation between USG and diuretic scintigraphic parameters. The secondary outcome was the predictive ability of the pelvicalyceal system parameters, measured by USG, of parenchymal growth after surgery. Results: Sixty-eight patients were evaluated. The mean age was 3.6 years (range 0.1-12). The mean (± standard deviation) differential renal function improved from 37.4 ± 11 ml/min to 37.7 ± 14 ml/min, which was a difference of no statistical significance.On the other hand, the mean (± SD) half-time (T_1/2) significantly improved. After constructing a linear regression model of the 4 USG parameters and the parenchymal growth, the model explained 57.2% of the variance in parenchymal growth after pyeloplasty. The calyx-to-parenchyma ratio change was the largest unique contribution for explaining the variance in parenchymal growth, followed by anteroposterior diameter and calyceal dilatation. Conclusion: We proved that calyx-to-parenchyma ratio, anteroposterior diameter and calyceal dilatation are independent predictors of early success after pyeloplasty.

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“…A series of studies by Chipde et al (10) and Longpre et al (11) showed that a high percentage of patients after pyeloplasty avoided diuretic isotope renography if the ultrasound parameters did not get worse. This issue can save time and money and avoid infections caused by catheterization for scanning and radiation from the follow-up scan.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Reliability of Kidney Ultrasound Findings After Pyeloplasty Versus Kidney Isotope Scans for Success in Patients with Ureteropelvic Junction Obstruction

et al. 2022

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Background: New parameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair. Methods: The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery. Results: A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72 mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43 mm. The mean kidney cortex diameter 6 months after surgery was 7.24 mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance half-time in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1. Conclusions: This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter.

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Factors Predicting Improvement of Renal Function After Pyeloplasty in Pediatric Patients: A Prospective Study

Abstract: Sonographic and urinary biochemical parameters may predict improvement in renal function after pyeloplasty. Pelvic anteroposterior diameter, pelvic cortical ratio and pelvic urine protein-to-creatinine ratio are the most useful parameters.

Cited by 19 publications

References 15 publications

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

Can Renal Ultrasonography Predict Early Success after Pyeloplasty in Children? A Prospective Study

Comparison of Reliability of Kidney Ultrasound Findings After Pyeloplasty Versus Kidney Isotope Scans for Success in Patients with Ureteropelvic Junction Obstruction

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