Background: Patients presenting with varying severity of obstructive urolithiasis behave differently after the treatment.
Some patients recover with improved renal function while others progress to renal failure.
Objective: To objectively quantify which patient would progress to renal failure following treatment for obstructive urolithiasis.
Material and Methods: A prospective analysis of 167 patients with renal failure due to bilateral obstructive urolithiasis who were treated and subsequently followed for at least 1 year was done. Failure was defined as GFR values less than 15 ml/min at 1 year follow up. All patient had pre-operative placement of percutaneous nephrostomy tube for at least 5 day before treatment with either ureteroscopy or percutaneous nephrolithotomy. Multiple logistic regression analysis of affecting parameters was done. A Renal deterioration index (RDI) was constructed based on scores assigned to varying severity of multivariate significant factors and ROC analyzed.
Results: 48(28.7%) patients progressed to CKD stage V at 1-year follow-up. Combined cortical width (≤ 0.001), proteinuria (0.01), positive urine culture (0.004) and nadir preoperative GFR post bilateral PCN (0.016) were statistically significant factors affecting renal deterioration on multi-variate analysis. RDI has high ROC curve (AUR=0.90) for predicting renal functional outcome. Combining these parameters in a prediction table yielded RDI score ≥12 being associated with high odds risk (OR=11.2) of treatment failure.
Conclusion: RDI ≥12 is associated with renal deterioration after appropriate treatment of bilateral obstructive urolithiasis.
Written by:
Mishra S, Sinha L, Ganesamoni R, Ganpule A, Sabnis RB, Desai M. Are you the author?
Muljibhai Patel Urological Hospital, Urology, Nadiad, Gujarat, India.
Reference: J Endourol. 2013 Mar 28. Epub ahead of print.
doi: 10.1089/end.2012.0456
PubMed Abstract
PMID: 23537205
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