Pyeloplasti Sonrası Böbrek Fonksiyonlarında Düzelme Olur mu? Düşük Renal Fonksiyonlu 13 Olgunun Değerlendirilmesi

Amaç: Üreteroplevik bileşke obstrüksiyonlu çocuk olgularda pyeloplasti sonrası fonksiyonel düzelme özellikle düşük fonksiyonlu böbreklerde halen tartışmalıdır. Literatürde opere edilen düşük renal fonksiyonlu olgularda iyileşme üzerine görüş birliği yoktur. Çalışmamızda düşük renal fonksiyonlu olgularda pyeloplasti sonrası iyileşme olup olmadığı amaçlandı.Gereç ve Yöntemler: Ocak 2009-Aralık 2015 tarihleri arasında opere edilen 80 olgudan 13 düşük fonksiyonlu olgunun preoperatif ve postoperatif diferansiye fonksiyonları, böbrek ön arka çapı ve parankimal kalınlığı değerlendirildi. Preoperatif ve postoperatif bulguların karşılaştırılması ile iyileşme olup olmadığına karar verildi.Bulgular: Diferansiye böbrek fonksiyonu %30’un altında olan 13 olgu değerlendirildi. 5 olgu antenatal hidronefrozi nedeni ile tanı alırken, 4 olgu üriner sistem enfeksiyonu sonrası, 4 olgu ise karın ağrısı semptomu ile tanı aldı. 13 olgudan 3’ünde postoperatif dönemde böbrek fonksiyonlarında %5’den fazla düzelme saptandı. Serimizde ameliyat öncesi ve sonrası böbrek fonksiyonları karşılaştırıldığında istatistiksel olarak anlamlı fark bulunmadı.Sonuç: Serimizdeki düşük fonksiyonlu UPJO nedeni ile pyeloplasti yapılan olgularda ameliyat sonrası bir değişiklik izlenmemiştir. Özellikle konservatif olarak izlenen hastalarda fonksiyon kaybı olmadan pyeloplasti yapılması önemlidir.

Anahtar Kelimeler:

Üreteropelvik bileşke tıkanıklığı, Düşük renal fonksiyon, Pyeloplasti

Is Differential Renal Function Improved After Pyeloplasty? Evaluation of 13 Cases with Low Differential Renal Function

Objective: Functional improvement after pyeloplasty in pediatric ureteropelvic junction obstruction (UPJO) is still debated, especially in poorly functioning kidneys. There is no consensus about the improvement of cases operated with poor renal function in the literature. In our study, we aimed to investigate whether there was an improvement after pyeloplasty in poor functioning cases. Material and Methods: Thirteen of the 80 cases operated between January 2009 - December 2015 with poor renal function were evaluated in terms of preoperative and postoperative differential functions, renal antero-posterior diameter and parenchymal thickness. We determined whether improvement was present by comparing preoperative and postoperative findings.Results: A total of 13 cases with differential renal function (DRF) less than 30% evaluated. Five of the cases were diagnosed after antenatal hydronephrosis, 4 after urinary tract infection and 4 following abdominal pain symptoms. Renal function improvement more than 5% was found in 3 of the 13 cases postoperatively. There was no statistically significant difference between preoperative to postoperative improvement of differential renal function in these series.Conclusion: There was no change in postoperative renal function in cases with low functional UPJO after pyeloplasty in our series. It is important to perform pyeloplasty before significant loss of function during the follow-up, especially in patients who are monitored conservatively

Keywords:

Ureteropelvic junction obstruction, Poor renal function, Pyeloplasty,

PDF

___

Kitchens DM, Herndon CD. Antenatal hydronephrosis. Current Urol Rep 2009;10:126-33.
Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 1990;144:584-7.
Thorup J, Jokela R, Cortes D, Nielsen OH. The results of 15 years of consistent strategy in treating antenatally suspected pelviureteric junction obstruction. BJU Int 2003;91:850-2.
Dhillon HK. Prenatally diagnosed hydronephrosis: The great ormond street experience. Br J Urol 1998;81:39-44.
Stock JA, Krous HF, Heffeman J, Packer M, Kaplan GW. Correlation of renal biopsy and radionuclide renal scan differential function in patients with unilateral ureteropelvic junction obstruction. J Urol 1995;154:716-8.
Salem YH, Majd M, Rushton HG, Belman AB. Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J Urol 1995;154:1889-93.
Wagner M, Mayr J, Hacker FM. Improvement in renal split function in hydronephrosis with less than 10% split function. Eur J Pediatr Surg 2008;18:156-9.
Barron BJ, Kim EE, Lamkin CM. Renal nuclear medicine. In: Sandler MP, Coleman RA, Patton JA, Wackers FJT, Gottschalk A (eds). Diagnosis Nuclear Medicine. 4th ed. Lippincott Williams Wilkins, 2003:865-8.
Sabg Won H, Seung Eon L, Jang Hwan K, Hyeon Joo, Koon Ho R, Seung Kang C. Does delayed operation for pediatric ureteropelvic junction obstruction cause histopathological changes? J Urol 1998;160:984-8.
Mc Aller IM, Kaplan GW. Renal function before and after pyeloplasty: Does it improve? J Urol 1999;162:1041-4.
Menon P, Rao KLN, Bhattacharya A, Mittal BR. Outcome analysis of pediatric pyeloplasty in units with less than 20% differential renal function. J Pediatr Urol 2016;12:171.e1-7.
Bansal R, Ansari MS, Srivastava A, Kapoor R. Long-term results of pyeloplasty in poorly functioning kidneys in the pediatric age group. Journal of Pediatric Urology 2012;8:25-8.