Analysis Of Influencing Factors Of Renal Function Recovery After Lifting Of Severe Hydronephrosis

Objective: To explore the influencing factors of renal function recovery in patients with severe hydronephrosis after relief of obstruction,so as to provide some reference for clinicians to treat patients with severe hydronephrosis and severely impaired renal function.Methods: A total of 141 cases diagnosed as severe hydronephrosis and severely impaired function due to unilateral upper urinary tract obstruction in the Department of Urology,The Third Affiliated Hospital of Zunyi Medical University from January2016 to December 2021 were retrospectively analyzed.All patients underwent surgical relief of upper urinary tract obstruction.According to the recovery of renal function from 3 to 12 months after surgery,the case data were divided into two groups:(a)obvious recovery group: GFR of affected kidney improved(postoperative to preoperative)≥5m L/min;(b)no obvious recovery group: GFR of affected kidney was improved < 5m L/min or decreased.Between the two groups of general information,history of alcoholism,smoking history,history of diabetes,hypertension medical history,cause of obstruction,operation method,serum creatinine,blood urea nitrogen,urinary tract infections,preoperative renal GFR,preoperative GFR,renal parenchyma thickness,the contralateral kidney RPV,kidney water volume and postoperative review GFR time follow-up(time)and other related indexes were analyzed.Univariate analysis was performed on the data between the two groups,and then multivariate Logistic regression analysis was further included to determine the factors that had independent influence on the recovery of renal function.The value of ROC test for independent factors in predicting postoperative renal function recovery.Resluts: Preoperative renal GFR < 10 ml /min in 47 cases,10 ~ 20 m L/min in 94 cases.82 cases had obvious recovery of renal function,59 cases had no obvious recovery,and 58.16% had obvious recovery.Of the 47 patients with GFR <10m L/min,18(38.30%)were significantly recovered after operation.Among 94 patients with 10-20 m L /min,64 patients(68.09%)recovered significantly after operation.There were statistically significant differences between the two groups in age,renal parenchymal thickness,hydronephrosis volume,RPV,follow-up time,preoperative renal GFR,preoperative renal GFR in the healthy side and urinary tract infection(P < 0.05).There were no significant differences in gender,BMI,smoking history,history of hypertension,history of alcoholism,history of diabetes,affected side,cause of obstruction,history time,surgical method,blood urea nitrogen,blood creatinine and urine p H between the two groups(P > 0.05).Multivariate Logistic regression analysis showed that age,RPV and parenchymal thickness were independent and significant influencing factors for renal function recovery.ROC curve was drawn to evaluate the three independent influencing factors.The AUC of age included in predicting postoperative renal function recovery was 0.757,and the maximum Yuden index was 0.419.At this time,the cut-off value was 50.5 years,the sensitivity was 62.20%,and the specificity was 79.70%.The AUC of RPV predicting postoperative renal function recovery was 0.845,and the maximum Yuden index was0.644.At this time,its truncation value was 59.75 ml,sensitivity was 78.00%,specificity was 86.40%.The AUC of renal parenchymal thickness for predicting postoperative renal function recovery was 0.738,and the maximum Yuden index was0.478,where the cut-off value was 5.965 mm,the sensitivity was 73.20%,and the specificity was 74.60%.Conclusions: For patients with severe hydronephrosis and severely impaired function,the younger the age,the greater the thickness of renal parenchyma and RPV,the more conducive to the recovery of renal function after obstruction relief.