The sequence of intervention determines the risk of early postoperative acute kidney injury in infants with bilateral ureteropelvic junction obstruction. Issue 6 (December 2022)

• Record Type: Journal Article
• Authors: Elbaset, Mohamed A.; Edwan, Mohamed; Elmeniar, Ali M.; Sharaf, Mohamed A.; Ezzat, Osama; Elgamal, Mostafa; Ashour, Rawdy; Abouelkheir, Rasha T.; Badawy, Mohamed; Soltan, Mohamed A.; Hafez, Ashraf T.; Dawaba, Mohamed; Abdelhalim, Ahmed
• Is Part Of: Journal of pediatric urology. Volume 18:Issue 6(2022)
• Page Start: 801.e1
• Page End: 801.e9
• Publication Date: 2022-12
• Subjects: Ureteropelvic junction obstruction -- Bilateral -- Pyeloplasty -- Acute kidney injury -- Differential renal function; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2022.08.002
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Introduction and objectives: The management of bilateral ureteropelvic junction obstruction (UPJO) is greatly debated. We aim to identify the risk of early postoperative acute kidney injury (AKI) in relation to the sequence of intervention in children with bilateral UPJO managed in a sequential manner. Methods: A single center database was retrospectively reviewed for children ≤2 years who underwent bilateral pyeloplasty. According to the differential renal function on the preoperative renograms, patients were categorized into group A : pyeloplasty on the poorer functioning kidney first and group B : pyeloplasty on the better functioning side first. Serum creatinine and eGFR, using the modified Schwartz formula, were evaluated at four time points (I): before the first intervention (II): within 48 h of the first intervention (III): before the second intervention and (IV): within 48 h of the second intervention. Preoperative and postoperative values were compared. The incidence of early postoperative AKI in both groups was defined according to the Acute Kidney Injury Network (AKIN) criteria. Results: The study comprised 46 children treated by staged pyeloplasty, 28 of them underwent pyeloplasty on the poorer functioning side first. Baseline serum creatinine and eGFR were not significantly different between both groups. Patients who underwent pyeloplasty on the poorer functioning side first, had a significant decline of eGFR after the first intervention (p = 0.006). Conversely, no significant eGFR changes were observed after the first or second interventions in the other group (figure). Overall, 64.3% and 33.3% of patients developed some degrees of AKI when intervention was started on the poorer and better functioning renal units, respectively (p = 0.04). Discussion: Bilaterality is seen in approximately ¼ of patients with UPJO. Oftentimes, both renal units are asymmetrically affected with little data to guide surgeons on the optimal sequence of intervention. Following pyeloplasty, 52.2% of the evaluated children with bilateral UPJO had early postoperative AKI, mostly of low stage. Our data suggest that intervening first on the better functioning side allows for better recovery of the renal functional reserve and lowers the risk of postoperative AKI. Conclusion: In children with bilateral UPJO, starting intervention on the poorer functioning kidney is associated with increased risk of postoperative AKI. Long-term prospective studies are needed to confirm our findings. Summary figure eGFR changes in both study groups (group A: intervention first on the poorer functioning renal unit, group B: intervention first on the better functioning renal unit), Y-axis shows eGFR values in ml/min/1.73m 2, X-axis shows points of evaluation throughout the study: Pre-op (1): before the first intervention, Post-op (1): within 48 h of the first intervention, Pre-op (2): before the second intervention, Post-op (2): within 48 h of the second intervention. Summary figure