Effect of emergent nephrostomy on long-term total and split renal function in patients with upper urinary tract obstruction due to pelvic malignant tumors
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In brief
In brief
This retrospective study examines whether emergent nephrostomy placement preserves kidney function in patients with pelvic tumors causing urinary obstruction. Results from seven pediatric oncology patients suggest nephrostomy improves total renal function and may help preserve split renal function in the affected kidney compared to conservative management.
- Nephrostomy placement significantly improved eGFR at end of treatment in patients with pelvic tumor-related UUTO.
- Patients without nephrostomy showed no improvement in eGFR despite tumor treatment.
- Split renal function remained impaired in affected kidneys even when total eGFR normalized.
- Nephrostomy was safely managed without severe infectious complications in this cohort.
- Early nephrostomy may preserve long-term renal function in malignant pelvic tumor patients with severe hydronephrosis.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aimed to investigate the impact of nephrostomies on the outcome of total renal function (TRF) and split renal function (SRF) in patients with malignant pelvic tumors associated with upper urinary tract obstruction (UUTO).
Methods
Patients with pelvic tumors suffering severe unilateral hydronephrosis treated at our hospital from 2000 to 2022 were included. Data for nephrostomy placement, short- and long-term renal function, and radiological and nuclear imaging studies were collected. The TRF and SRF of patients who underwent nephrostomy were compared to those who did not.
Results
Seven patients were included (rhabdomyosarcoma: 5, ovarian germ cell tumor: 1, malignant rhabdoid tumor: 1). Nephrostomies were placed in four, which were successfully managed without severe infections. Estimated glomerular filtration rate (eGFR) was significantly improved at the end of treatment in patients with nephrostomy. In contrast, eGFR in patients who did not undergo nephrostomy was not improved. Nuclear imaging studies (renograms or renal scintigrams) revealed impaired SRF of the affected kidney compared to the contralateral kidney, even in patients whose eGFR was within normal levels. Notably, SRF showed a trend to improve over time in one patient treated with nephrostomy.
Conclusion
Nephrostomy for UUTO caused by pelvic tumors may improve renal outcome.