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
UroToday.com Stone Disease Section

This webpage is supported through an unrestricted educational grant from Bayer. Bayer is not involved in content development and the views expressed represent those of the patient and physician contributors.

