Management of non-functioning kidney due to pelvi-ureteric junction obstruction in pediatric age group: an observational study
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In brief
In brief
This retrospective study of 15 pediatric patients demonstrates that non-functioning kidneys (<10% split renal function) due to PUJO can be salvaged through staged management with percutaneous nephrostomy followed by pyeloplasty. All patients showed significant functional improvement (mean SRF 6.67% to 16.80%) after 3 months of PCN drainage, avoiding nephrectomy.
Written by the GCMD Library team from the article.
Abstract
Introduction
A non-functional kidney (NFK) has been defined as one having paper-thin parenchyma, and split renal function (SRF) of < 10% on a nuclear scan. There are differences of opinion about nephrectomy or pyeloplasty in these patients. The present study was conducted to assess our management strategy of renal salvage for NFK.
Materials and methods
It was a retrospective cohort study from January 2015 to July 2022, patients having SRF < 10% were included. These patients underwent ultrasound-guided percutaneous nephrostomy (PCN). A repeat nuclear scan was performed after 3 months. If SRF increased to > 10%, pyeloplasty was performed.
Results
Fifteen patients were managed. The mean age was 24.67 ± 23.61 months. Male to female ratio was 4:1. The initial mean SRF was 6.67 ± 2.85, which improved to 16.80 ± 4.69 after 3 months of placing the PCN (p < 0.001). The corresponding changes in the mean effective renal plasma flow (ERPF) were 60.13 ± 24.08 to 106.53 ± 24.61 (p < 0.001). There was no complaint after the placement of PCN. All patients underwent dismembered pyeloplasty.
Conclusion
In NFK due to PUJO, expectant treatment in form of PCN followed by pyeloplasty appears to be the primary treatment modality, and nephrectomy may not be needed in any of them.