Clinical Significance Of Urine Analysis After Percutaneous Renal Pelviostomy In Children With Extremely Severe Hydronephrosis

Aims:To investigate the feasible of urine analysis from percutaneous nephrostomy(PCN)in children with extremely severe hydronephrosis,with purpose to identify the clinical application value of PCN for choosing therapeutic regimens(nephron sparing surgery/nephrectomy)of extremely severe hydronephrosis in children.Methods:A total of 20 patients with DRF below 10%had been screened in the patients with congenital extremely severe hydronephrosis from March 1,2015 to March 31,2017,and were selected as the subjects of the study.On admission,records were collected of the patients' names,sexes,ages,anteroposterior diameters of the renal pelvis,imaging exams,presence of urinary tract infection,urinary biochemical assay including creatinine(Cr),?1 micro-protein(?1-MG),albumin(Alb),?2 micro-protein(?2-MG),immunoglobulin G(IgG),transferrin(TFN),ECT results,etc.20 patients were underwent percutaneous nephrostomy first,the daily drainage of urine quantity and color were recorded for 3 months,the urine biochemistry,drainage of urine were analyzed in 24 hours and 3 months later of percutaneous nephrostomy.ECT was poformed after 3 months of percutaneous nephrostomy.8 patients with none improvement in renal function were underwent nephrectomy(nephrectomy group),20 patients with improvement in renal function were underwent pyeloplasty(nephron sparing group).Retrospectively studied the differences in average daily drainage of urine after percutaneous nephrostomy between the two groups,the differences of urine biochemistry in 24 hours and 3 months later of percutaneous nephrostomy in nephrectomy group,the differences of urine biochemistry in 24 hours and 3 months later of percutaneous nephrostomy in nephron sparing group.Results:In twenty patients with extremely severe hydronephrosis,the anteroposterior diameters of renal pelvis were expanded(>5.5 cm),preoperative of DRF<10%.There was no significant difference of urine volume of the renal pelvis after percutaneous nephrostomy between nephrectomy group and nephron sparing group(P>0.05).In nephrectomy group,there was no statistically significant difference of urine creatinine,?1 micro-protein,?2 micro-protein and immunoglobulin G between in 24 hours and 3 months later of percutaneous nephrostomy(P>0.05),and were statistically significant differences of albumin and transferrin between in 24 hours and 3 months later of percutaneous nephrostomy(P<0.05).In nephron sparing group,there were statistically significant differences of urine creatinine,al micro-protein,albumin,?2 micro-protein,immunoglobulin G,transferrin between in 24 hours and 3 months later of percutaneous nephrostomy(P<0.01).Conclusion:It is feasible and safety of PCN for extremely severe hydronephrosis in children.PCN is a very low in risk of surgical anesthesia,and is considered as routine treatment for extremely severe hydronephrosis.After 24 hours and 3 months of PCN,urinary creatinine and protein of drainage urine of affected kidney were analyzed,and results is effective to understand the renal function recovery,and provide help for the surgical regimens.