Analysis of factors influencing poor recovery of renal function after unilateral severe hydronephrosis with relief of obstruction

Abstract

Objective To analyze the factors influencing poor recovery of renal function in patients with severe unilateral hydronephrosis after relief of obstruction， providing evidence for predicting the recovery of renal function. Methods Clinical data of 55 patients with severe unilateral hydronephrosis and glomerular filtration rate （GFR） < 10 mL/min admitted to Tungwah Hospital from 2015 to 2022 were retrospectively analyzed. All patients underwent percutaneous nephrostomy for temporary relief of the obstruction. Based on the recovery of renal function， all patients were divided into the recovery group and non-recovery group， and the factors influencing renal function recovery after nephrostomy were collected and analyzed. Results Among 55 patients treated with percutaneous nephrostomy for severe hydronephrosis， renal function was recovered in 30 cases （54.5%）， and poor recovery in 25 cases （45.5%）. Univariate analysis showed no significant differences in terms of gender， side， body mass index （BMI）， history of diabetes mellitus， history of hypertension， pre-nephrostomy GFR， and urinary pH of the affected kidney between the recovery and non-recovery groups （all P > 0.05）. However， there were significant differences in age， renal parenchymal thickness， ratio of GFR of the affected kidney to total GFR， presence of renal infection， and post-nephrostomy urinary output of the affected kidney between two groups （all P < 0.05）. Further multivariate logistic regression analysis showed that a pre-nephrostomy ratio of GFR of the affected kidney to total GFR （OR=0.24， 95%CI 0.06-0.98） and a post-nephrostomy urinary output of the affected kidney （OR=0.04， 95%CI 0.01-0.25） were the independent influencing factors of poor recovery of renal function after nephrostomy. Conclusions Partial patients with severe unilateral hydronephrosis and a GFR <10 mL/min can obtain renal function recovery after temporary relief of obstruction via percutaneous nephrostomy. The pre-nephrostomy ratio of GFR of the affected kidney to total GFR <10% and post-nephrostomy urinary output of the affected kidney <400 mL/day are the independent influencing factors for poor recovery of renal function， which can guide clinicians in predicting renal outcome.

Keywords

• hydronephrosis|ureteral obstruction|renal function|glomerular filtration rate|percutaneous nephrostomy