The Recovery Of Renal Function After Percutaneous Nephrostomy With Severe Hydronephrosis Due To Obstruction

Objective:To observe the residual renal function before and after PCN intervention in adult patients with severe obstructive hydronephrosis whose SRF<10%,to explore the evaluation method and value of single kidney function,and to optimize the management strategy of these patients.In order to maximize the benefits of renal function.Methods:44 cases of severe hydronephrosis with SRF<10%were collected from June 2016 to September 2017 in our hospital.After PCN drainage,2 cases were diagnosed as purulent renal excretion,and 42 cases were included,among them 23 cases were males and 19 cases were females.1.PCN and circumference PCN assessment of the expected renal function:1)?The thickness of the affected renal parenchyma was measured by CT scanning about 12 weeks after PCN.2)?PH value and specific gravity of renal pelvis were measured at 12 weeks after PCN.3)?About 12 weeks after PCN?GFR?SRF in of the affected kidney was determined by radionuclide dynamic renal scanning.4)?After PCN 24 and 12 weeks after PCN the 24 hour drainage volume of the affected kidney was calculated for 3 consecutive days(as the urine volume of the affected kidney 24 hours).2.Grouping and related factor analysis:According to the standard of increasing value of renal SRF ? 5and SRF?10%after recovery of PCN,the subjects were divided into two groups:renal function improvement group,renal function improvement group,age group(age group),age group(youth group,middle age group,sex group).There was no statistical difference in drainage time(week)between the affected renal side and renal side.The relationship between age,sex,renal side and renal function improvement was analyzed.3.The evaluation index of unilateral renal function:compare the thickness of GFR?SRF,the thickness of renal parenchyma,the PH value of renal pelvis urine volume,the difference of urine specific gravity before PCN and after PCN and the correlation of renal parenchymal thickness,renal pelvis urine volume,urine specific gravity and GFR.Results:1.A11 44 patients were treated with PCN intervention and 2 patients were excluded from the group after diagnosis of pyonephrosis.The remaining 42 cases were re-entered into the group.After PCN drainage,16 cases of the affected kidney function were improved,and the obstruction was relieved by operation.In 26 patients,the renal function of the affected side was not improved significantly,and the affected kidney was resected.2.In the renal function improvement group and the unimproved group,the difference of age(age),age(youth group,middle age group)was statistically significant(p<0.05).There was no significant difference in the number of male and female patients,the number of patients with left and right side of kidney and the time of PCN drainage.There was no correlation between the patient's sex,the side of the affected kidney and the improvement of renal function(P>0.05),but there was a correlation between age and the improvement of renal function(P<0.05).3.The 24 hour urine volume and urine specific gravity of the affected kidney were significantly correlated with the corresponding GFR,and the correlation after PCN was higher than that before PCN.Conclusions:1.After drainage with PCN,the renal function of some patients with severe hydronephrosis(SRF<10%)was improved in varying degrees,especially in younger patients.2.Before the obstruction was relieved,the indexes of renal function evaluation could not truly reflect the residual function of the affected kidney,and the SRF<10%before the relief of the obstruction could not be used as the basis for renal failure or nephrectomy.3.The thickness of renal parenchyma,urine volume of 24 hours,urine PH value and urine specific gravity are all reliable indexes to evaluate the renal function of patients with PCN.The above indexes can better evaluate the improvement of renal function after PCN.