Prevalence and risk factors of post obstructive diuresis afterpercutaneous nephrostomy in obstructive nephropathy patients
Objective: To identify the prevalence and risk factors of post-obstructive diuresis after percutaneous nephrostomy in obstructive nephropathy patients who have functional or anatomic renal damage from urinary tract obstruction.
Material and methods: Between October 2011 and November 2014, obstructive nephropathy patients who had hydronephrosis, diagnosed by ultrasound or CT scan, acute kidney injury from blood test and underwent percutaneous nephrostomy at Rajavithi Hospital were enrolled in this retrospective study. Patient demographics, kidney characteristics, clinical and laboratory values were collected at the time of admission and analyzed for risk factors of post obstructive diuresis using univariate and multivariate analysis.
Results: Of 305 patients with obstructive uropathy, 229 patients were eligible for inclusion based on our eligibility criteria. Of 229 patients included, 142 had complete data available. Post obstructive diuresis occurred in 61 of the 142 (43%) patients. Single kidney (OR 6.13, 95% CI 1.48-25.32, p=0.012) and low glomerular filtration rate (GFR) (OR 0.94, 95% CI 0.90-0.98, p=0.005) independently predicted post obstructive diuresis after multivariate analysis.
Conclusion: Prevalence of post obstructive diuresis was about 43%. Our study demonstrated that single kidney and low GFR are risk factors for post obstructive diuresis. However, a large prospective study is required to further investigate these findings.
2. Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, communitybased study. Kidney Int 1996;50:811-818.
3. Khan IH, Catto GR, Edward N, et al. Acute renal failure: Factors influencing nephrology referral and outcome. QJM 199;90:781-785.
4. Yarger WE, Schocken DD, Harris RH. Obstructive nephropathy in the rat: Possible roles for the renin-angiotensin system, prostaglandins, and thromboxanes in postobstructive renal function. J Clin Invest 1980;65:400-412.
5. Sophasan S, Sorrasuchart S. Factors inducing post -obstructive diuresis in rats. Nephron 1984; 38:125-133.
6. Li C, Wang W, Kwon TH, et al. Altered expression of major renal Na transporters in rats with bilateral ureteral obstruction and release of obstruction. Am J Physiol Renal Physiol 2003; 285:F889-901.
7. Chevalier RL, Forbes MS, Thornhill BA. Ureteral obstruction as a model of renal interstitial fibrosis and obstructive nephropathy. Kidney Int 2009;75:1145-1152.
8. Vaughan ED Jr, Gillenwater JY. Diagnosis, characterization and management of postobstructive diuresis. J Urol 1973;109:286-292.
9. Bishop MC. Diuresis and renal functional recovery in chronic retention. Br J Urol 1985; 57:1-5.
10. Oster JR, Singer I, Thatte L, et al. The polyuria of solute diuresis. Arch Intern Med 1997;157: 721-729.
11. Harris RH, Yarger WE. The pathogenesis of post-obstructive diuresis. The role of circulating natriuretic and diuretic factors, including urea. J Clin Invest 1975;56:880-887.
12. Schlossberg SM, Vaughan ED Jr. The mechanism of unilateral post-obstructive diuresis. J Urol 1984;131:534-536.
13. Maher SF, Schreiner GE, Waters TJ. Osmotic diuresis due to retained urea after release of obstructive uropathy. N Engl J Med 1963;268: 1099-1104.
14. Noble VE, Brown DFM. Renal ultrasound. Emerg Med Clin N Am 2004;22:641-59.
15. Moghazi S, Jones E, Schroepple J, et al. Correlation of renal histopathology with sonographic findings. Kidney Int 2005;67:1515-1520.
16. Hamdi A, Hajage D, Van Glabeke E, et al. Severe post-renal acute kidney injury, post-obstructive diuresis and renal recovery. BJU Int 2012;110(11 Pt C):E1027-34.
17. Nyman MA, Schwenk NM, Silverstein MD. Management of urinary retention: rapid versus gradual decompression and risk of complications. Mayo Clinic Proceedings; 72:951-956.
Copyright (c) 2017 วารสารยูโร (The Thai Journal of Urology)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.