Obstructive Uropathy with Renal Failure OC28-OC30
Dr. Girish P Vakrani,
A29, Vydehis Quarters, Whitefield, Bangalore-560066, Karnataka, India.
Introduction: Renal failure is often seen with Urinary Tract Obstruction (UTO), which could be acute or chronic (obstructive nephropathy). With early diagnosis and treatment, it is often reversible. The data being sparse in literature, hence this study was planned.
Aim: The present retrospective study was undertaken to discuss about causes, pathophysiology, site of obstruction, clinical features, diagnostic tests, management and factors affecting renal failure outcomes in cases of obstructive uropathy.
Materials and Methods: All outpatient and inpatient cases of obstructive uropathy in 2016 were included and were subjected for renal function tests, radiological investigations. Stenting, diversion surgeries were performed to relieve obstruction. Studentâ€™s t-test, Leveneâ€™s test, chi-square/Fisher Exact-test were used for statistical analysis.
Results: Of the 107 patients enrolled, bilateral UTO, intrinsic cause, chronic obstruction (>3 months duration), acute on Chronic Kidney Disease (CKD), Acute Kidney Injury (AKI), most common site of obstruction was ureter, seen in 58 (54%), 78 (72%), 71 (66%), 63 (58%), 44 (41%) and 47 (43%) cases respectively. Among co-morbities, history of past Urinary Tract Infection (UTI), past urological surgeries and diabetes mellitus were seen in 70 (65%), 62 (57%), and 62 (57%) cases respectively. Among the aetiology, blood clots, abdomen lymphadenopathy, ureter calculus were seen in 62 (57%), 16 (15%), and 14 (13%) cases respectively. Most common symptom was pain abdomen present in 98 (91%) cases. Among the complications, UTI was seen in 65 (60%). Dialysis therapy and most common urological intervention, ureter stenting was needed in 38 (35%) and 37 (34%) cases respectively. Renal failure recovery, post obstructive diuresis, death were noted in 34 (31%), 25 (23%) and 18 (16%) cases respectively.
Conclusion: Comparing with renal failure recovered group, the non recovered group had statistically significant dominant males, were much older, had higher incidence of congenital blocks, acute on CKD, Pelvi-Ureter Junction (PUJ) obstruction, blood clots, abdomen lymphadenopathy, weight loss, abdomen mass, mineral bone disorder, emphysematous Acute Pyelonephritis (APN), lower haemoglobin, leukocytosis, dialysis need and Extracorpeal Shock Wave Lithotripsy (ESWL) therapy.