Author/Authors :
rajadoss, muthukrishna p. christian medical college and hospital - department of urology, India , berry, chandrasingh jeyachandra christian medical college and hospital - department of urology, India , rebekah, grace j. christian medical college and hospital - department of biostatistics, India , moses, vinu christian medical college and hospital - department of radiology, india , keshava, shyamkumar n. christian medical college and hospital - department of radiology, India , jacob, kuruthukulangara s. christian medical college and hospital - department of psychiatry, india , kumar, santosh christian medical college and hospital - department of urology, India , kekre, nitin christian medical college and hospital - department of urology, India , devasia, antony christian medical college and hospital - department of urology, India
Abstract :
Objectives: To identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis. Patients and methods: Data from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of 62 mg/dL. Results: In all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged 640 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of 625 days (P 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of 16.5 mm (P = 0.001), and haemoglobin 9.85 g/dL (P 0.01) were significant on unadjusted analysis. Symptom duration of 625 days alone remained significant after adjusted analysis. Symptom duration of 625 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52–42.26; P 0.01), parenchymal thickness of P16.5 mm (HR 5.91, 95% CI 1.94–17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32–75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of 625 days (HR 17.44, 95% CI 2.48–122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of 625 days (P = 0.007) was 22-times more likely to indicate renal recovery. Conclusions: Shorter symptom duration (625 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.
