To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Abstract

What's known on the subject? and What does the study add? ÖZ AmaçÇalışmamızda akut/subakut tek taraflı komplet üreteral tıkanıklığa bağlı böbrek fonksiyonlarının nefrostomi ile tedavi sonrası değişimini göstermek amaçlanmıştır. gereç ve yöntemOtuz hasta prostpektif olarak çalışmaya dahil edilmiştir. Hepsinin üreter taşı olup 24'ünde (%80) üst üreter ve 6'sında (%20) orta üreter yerleşimliydi. Tüm hastaların ileri düzeyde hidronefrozu olduğu için perkütan nefrostomi takılması planlandı. Nefrostomi takıldıktan sonra 1. haftada etkilenen böbrek nefrostomiden ve diğer böbrek üretral kreatinin klirensi ölçümü ile değerlendirilmiştir. Değişikliği saptamak için de 1. ayda nefrostomi ve üretral kreatinin klirensleri hesaplanıp 1. haftadaki sonuçlar ile karşılaştırılmıştır. BulgularHastalarımızın ortalama yaşı 44,6'dır (36-54). Etkilenen böbreğin 1. haftadaki kreatinin klirensi 38,8±4,9 ml/dak iken 1. aydaki değer 42,5±5,4 ml/dk'ya yükselmiştir (p<0,001). Tüm hastaların kreatini klirens analizlerinde %2,3 ile %17,3 arasında artış saptanmıştır. SonuçÇalışma sonuçlarımıza göre tek taraflı komplet üreteral tıkanıklığa bağlı bozulan böbrek fonksiyonu nefrostomi takılması sonrası 1. ayda 1. haftaya göre anlamlı olarak düzelmektedir. Bu düzelme böbrek fonksiyonları sınırda olan tek taraflı tıkanıklığı olan hastalarda asıl tedaviye veya nefrektomi yapmaya karar vermede etkili olacaktır. Anahtar KelimelerKreatinin klirens, nefrostomi, obstrüktif üropati objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and MethodsThirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. ResultsThe mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8±4.9 ml/min in the first week of urinary diversion and increased to 42.5±5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5±4.7%. ConclusionAccording to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidney KeywordsCreatinine clearance, nephrostomy, obstructive uropathy This is first study that evaluated the renal function change after relief of unilateral ureteral obstruction because of ureteral stones.

Sex Difference in MasR Expression and Functions in the Renal System

“…In another study, after a moderate renal I/R, A779 alone or A779 + PD123319 (AT2R antagonist) infusion increased the RBF and RVR responses to Ang II infusion significantly in females but not in the male rats [101], so that simultaneous AT2R and MasR blockade decreased renal vasoconstriction following Ang II infusion. Unilateral ureteral obstruction (UUO) via producing local vasoactive factors leads to increased RVR, decreased RBF, and renal hemodynamic impairment [102, 103]. Hassanshahi and Nematbakhsh showed that Ang 1-7 infusions significantly increased RBF and decreased RVR in sham, UUO, and RUUO (UUO removal) groups [104].…”

Reversal Unilateral Ureteral Obstruction: A Mice Experimental Model

“…A better understanding of its pathogenesis and deploying effective therapies may reduce the global burden of end-stage renal disease. The therapeutic strategies of UUO have remained as main goal for urologists and nephrologists [3].…”