A retrospective analysis of 34 patients of obstructive renal failure, initially managed by percutaneous nephrostomy was performed. Pre procedure blood biochemical profile was compared with upto one week follow-up of blood chemistry. There was a decline of 71.1% and 56.08% (P-values 0.0001 and 0.0028) in the mean values of serum creatinine and blood urea nitrogen respectively at 7 days after the procedure. Improvement in blood biochemical profile was solely dependent on performance of percutaneous nephrostomy

Ahmed, I

Ahmed, M N

Aslam, A

Hussain, Y A

Rizvi, I H

English

eCommons@AKU

eCommons@AKUDepartment of Radiology Medical College, PakistanJanuary 1995Effectiveness of percutaneous nephrostomy inreversing obstructive renal failureI AhmedI H. RizviA AslamM N. AhmedAga Khan University, nadeem.ahmed@aku.eduY A. HussainFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationAhmed, I., Rizvi, I. H., Aslam, A., Ahmed, M. N., Hussain, Y. A. (1995). Effectiveness of percutaneous nephrostomy in reversingobstructive renal failure. Journal of Pakistan Medical Association, 45(1), 16-18.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/180Effectiveness of Percutaneous Nephrostomy in ReversingObstructive Renal FailurePages with reference to book, From 16 To 18 Iftikhar Ahmed, Imtiaz Hussain Rizvi, Mohammad Nadeem Ahmed, Yusuf A. Hussain ( Departments of Radiology, The AgaKhan University Medical Centre, Karachi. ) Asif Aslam ( Departments of Community Health Sciences, The Aga Khan University Medical Centre, Karachi. ) Abstract A retrospective analysis of 34 patients of obstructive renal failure, initially managed by percutaneousnephrostomy was performed. Pre procedure blood biochemical profile was compared with upto oneweek follow-up of blood chemistry. There was a decline of 71.1% and 56.08% (P-values 0,0001 and0.0028) in the mean values of serum creatinine and blood urea nitrogen respectively at 7 days after theprocedure. Improvement in blood biochemical profile was solely dependent on performance ofpercutaneous nephrostomy (JPMA 45:16,1995).Introduction Percutaneous nephrostomy is a commonly performed image guided intervention to relieve urinaryobstruction1-4. In the modern radiological practice, most common indication for this procedure isobstructive uropathy thatis frequently caused by calculus disease5. Percutaneous nephrostomy itself isthe definitive therapeutic intervention in cases where transient supra-vesical urinary diversion isneeded. Percutaneous access to the renal collecting system is also used for other endourologicalprocedures6,7. Elective surgical management may be deferred until the blood chemistiy has returnedtowards normal in patients who cannot be offered definitive percutaneous management.Nephrostomically produced urinary diversion helps reverse the changes in the renal parenchyma relatedto back pressure. Improvement in biochemical profile after relief of obstruction is well known inexperimental animals and humans8-10. Literature review, however, has revealed a lack of studies,quantitatively analyzing the change in blood chemistry in response to supra- vesical urinary diversionprovided by percutaneous nephrostomy. In this paper, the effectiveness of percutaneous nephrostomywas assessed in reversing the biochemical manifestations of obstructive renal failure in clinical settings.Patients and Methods This is a descriptive study of patients who had percutaneous nephrostomy performed within a period oftwo years from January, 1990 at the Department of Radiology, The Aga Khan University MedicalCentre. Two criteria of case selection were used for the study: a) All cases of obstructive renal failureinitially treated by percutaneous urinary diversion, b) All cases in which the complete biochemicalprofile was available for retrospective evaluation. A total of34 cases were thus selected. Thenephrostomies were perfonned either as an emergency or elective procedure by the staff and the seniorresidents having different levels of expertise. The procedure was first explained to the patient. Localanaesthesia was used in all the cases except one 3 year old child who was given inhalationalanaesthetics. Premedication with antibiotics and sedatives was used selectively in patients in whom theneed was clinically obvious. In all cases, initial localization was performed by ultrasound11,12. This inmost cases was followed by antegrade pyelogram13 with the patient in prone oblique position14. Forcatheter insertion, angiographic guidewire exchange or catheter sheathed needle insertiontechniques15,16 were used underfluoroscopic cover. The catheters were pulled from 7Fr radio- opaquepolyethylene tubing (Cook Inc.) in the Department of Radiology. For securing the catheters to the skin,silk stay sutures were used. Baseline biochemical investigations included serum electrolytes, creatimneand blood urea nitrogen levels. Blood urea nitrogen and serum creatinine were selected as renalfunction parameters17. These tests are routinely performed on patients suspected of having derangedrenal functions. Serum creatinine and blood urea nitrogen levels were analyzed before the insertion ofthe nepluDstomy tube and were followed-up at one, three and seven days intervals after the tubeplacement. The analysis was performed using "Excel" computer software and paired student t test ofstatistical significance was applied.Results Out of 34 patients studied, 29 were males and 5 females, between 3 and 78 years of age. Percutaneousnephrostomy was achieved in all the 34 patients without failure in first attempt. Thiiteen patientsneeded bilateral tube placement. Twenty-six nephrostomy tubes were placed in patients having calculusdisease; of these, 8 presented in emergency service for acute urinary obstruction while 18 sufferedchronic renal obstruction. Urinary diversion was perfomied in 8 patients to relieve chronic obstructioncaused by urinary tract malignancy. The procedures were relatively free of complications, two patientsneeding long term drainage, dislodged their nephrostomy tubes after discharge from the hospital. Allpatients had transient hematuria which did not require transfusion and lasted less than 48 hours. In allthe patients, a gradual decline in serum creatimne and blood urea nitrogen values (Figure) wasobserved.At one week follow-up, 71.1% and 56.0% decline in the serum creatinine and blood observed (P values0.0001 and 0.0028 respectively). All the patients showed marked clinical improvement evidenced bybiochemical profile and symptomatic relief.Discussion Obstructive uropathy is a backpressure phenomena which leads to renal parenchymal damage. Theextent of damage is dependent on duration, completeness and level of obstruction and the vascularstatus of the kidney18. The gradual decline in the mean values of serum creatinine and blood ureanitrogen as depicted in the figure demonstrates the effectiveness of percutaneous nephrostomy inobstructive renal failure patients. In general, patients with higher baseline serum creatinine and bloodurea nitrogen values did not return to normal. All these patients had long standing disease resulting inrenal parenchymal damage. There was, however, a statistically significant decrease in their serumcreatinine and blood urea nitrogen values (P value 0.0001 and 0.0028 respectively), thus showing adirect relationship between the performance of percutaneous nephrostomy and the change inbiochemical profile. This study shows that supra-vesical urinmy diversion provided by percutaneousnephrostomy is extremely effective in restoring the renal functions towards normal in patients havingobstructive renal failure. Nephrostomy is a very effective intervention for patients requiring definitiveurinary surgery, but with high risk of anaesthetic complications and those in need of urgent urinarydiversion.References 1. Barbric, Z.L. and Wood, B.P, Emergency percutaneous nephrostomy. Experience with 34 patientsand review of literature. AJR., 1977; 128:435-58.2. Barbric, Z.L. Percutaneous nephrostomy for urinafy tract obstruction. AJR., 1984; 143:803-809.3. Barbric, Z.L. Interventional uroradiology. Radiol. Clin. North Am., 1979;1 7:413-33.4. Perinetti, E., Catalona, W.J., Manley, C.B. et al. Percutaneous nephrostomy: indications,complications and usefulness. J. Urol., 1978; 120:156-58.5. Stables, D.P., Ginsberg, N.J. and Johnson, M.L. Percutaneous nephrostomy: A series and review ofliterature. AJR., 1978; 130:75-82.6. Smith, AD., Paul, H.L. and Fraley, E.E. Application of percutaneous nephrostomy: New challangesand opportunities in endourology. J. Urol., 1979;121 :382.7. Lang, E.K. and Price, IT. Redefinition of indications of percutaneous nephrostomy. Radiology,1983;147:419-26.8. Better ,O.S., Arieff, Al., Massiy, S.G. et al. Studies on renal function after relief of completeunilateral ureteral obstruction of three months duration in man. Am. J. Med., 1973;54:234-40.9. Muldowney, F.P., Duffy, G.J., Kelly, D.G. et al. Sodium diuresis after relief of obstructive uropathy.N. Engi. J. Med., 1 966;274: 1294-98.10. Brunschwing, A., Barber, H.R. and Roberts, S. Return of renal function after varying periods ofureteral obstruction. A clinical study. JAMA., l964;188:5-8.11. Pederson, iF., Cowan, D.F., Krist, J. et al. Ultrasonically guided percutaneous nephrostomy.Radiology, 1976; 119:429-32.12. Hary, G.Z., Howard, M., Marc, P. et al. Percutaneous nephrostomy comparison of sonographic andfluoroscopic guidance. Radiology, 1981; 147:925-27.13. Kaye, K.W. Renal anatomy for endourologic stone removal. J. Urol, 1983; 130:647-48.14. Jefery, H.N. and Richard, C.P. Antegrade pyelography. In: Christos, A. Adhanasoulis, Richard, C.,,Pfister, Reginald, E. Green, Glenn, H. Roberson (ads.) Inteventional Radiology. Philadelphia WBSaunders, 1 982;pp.437-54.iS. Harris, RD., McCullough, D.L. and Talner, L .B. Percutaneous nephrostomy. J. Urol.,1976;115:628-31.16. Raz, S. A simple method of pyonephrosis drainage. Lancet, 1971 ;2:529-30.17. Martin, P.J. Laboratory Investigations. In: O’Reilly PH. (eds). Obstructive uropathy. Great BritainBerlin, Heidelberg, Springer- Verlag, 1986;pp.631-70.18. Gillenwater, J.Y. The pathophysiology of urinary obstruction. In: Campbell MF and Harrison JR(eds.) Urology Vol. 3. eds. Philadelphia, WB Saunders Co, 1970, pp. 58-186.

Effectiveness of percutaneous nephrostomy in reversing obstructive renal failure

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1179&amp;context=pakistan_fhs_mc_radiol

Effectiveness of percutaneous nephrostomy in reversing obstructive renal failure

Abstract

Similar works

Full text

Available Versions

eCommons@AKU