Predicting factors for improvement of serum creatinine after percutaneous nephrostomy in adults with bilateral hydronephrosis associated with malignancy
Objective: Improvement of renal function in obstructive uropathy is a main goal of urinary diversion. In cases of failed internal diversion, percutaneous nephrostomy (PCN) is used to divert urine from the obstructed kidney. PCN also affect on quality of life, particularly having both sides. The objective of this study was to identify a predicting factor associated with improvement of renal function after bilateral PCNs and to avoid performing bilateral PCNs.
Materials and Methods: Data of all patients with bilateral hydronephrosis associated with malignancy who were performed bilateral PCNs in Siriraj Hospital between December 2011 and December 2016 were reviewed and collected. Success with PCN was defined as a serum creatinine less than 2 mg/dl or decreased more than 95% of initial serum creatinine.
Results: A total of 240 patients met the criteria. Mean age was 64.6 ± 14.9 years old. Most common organ of malignancy was cervix. Mean initial serum creatinine (iCr) and nadir serum creatinine (nCr) were 7.7 and 1.9 mg/dl, respectively. On multivariate analysis, no significant predicting factors were demonstrated but only iCr tended to have a statistically significant (p = 0.058). From receiver operating characteristics analysis, at cut-off value of iCr 5 mg/dl could demonstrate significant difference between success and failure (p = 0.027). Sensitivity and specificity were 72.4% and 44.0%, respectively.
Conclusion: Only the iCr was more likely to be a predicting factor. At cut-off value of iCr 5 mg/dl, if a patient presented with iCr more than 5 mg/dl and unilateral PCN at dominant side did not improve serum creatinine, performing contralateral PCN might not help.
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