Dataset Information

Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study.

ABSTRACT:

Background

Serum creatinine trajectory (SCr-Tr) is a neglected prognostic tool for chronic and acute kidney injury. We aimed to assess the predictors of SCr-Tr during the time-to-nadir and serum creatinine (SCr) normalization rate after drainage, using percutaneous nephrostomy in patients with bilateral malignant ureteral obstruction.

Methods

A prospective non-randomized study was performed on SCr-Tr in patients with bilateral malignant ureteral obstruction from August 2019 to March 2022. The primary outcome was SCr-Tr during the time-to-nadir.

Results

This study included 102 patients with a mean age ± SD of 59.6 ± 14.7 years. SCr-Tr was non-linear with a mean ± SD (range) of 0.5 ± 0.4 (0.03-2.3) mg/dl/day. Multivariate analyses revealed that female gender (p = 0.016), body mass index (BMI; p = 0.005), and SCr at presentation (p < 0.001) were predictors of rapid SCr-Tr during the time-to-nadir. However, age (p = 0.008) and low urine output at presentation (p = 0.015) were associated with a lower SCr-Tr. In contrast, laterality of drainage (p = 0.544) and mean parenchymal thickness (p = 0.066) were not associated with mean SCr-Tr. Also, only the mean parenchymal thickness (p = 0.002) was a predictor of rapid SCr-Tr at ≥ 0.5 mg/dl/day. However, low BMI (p = 0.023) was associated with a high SCr normalization rate, while unilateral drainage (p = 0.045) was associated with a lower rate.

Conclusions

Female gender, low BMI, and SCr at presentation were predictors of rapid SCr-Tr during the time-to-nadir. Bilateral drainage was an independent predictor of SCr normalization rate, but not of rapid SCr-Tr. The mean parenchymal thickness was the only independent predictor for rapid SCr-Tr at ≥ 0.5 mg/dl/day.

SUBMITTER: Gadelkareem RA

PROVIDER: S-EPMC9948309 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study.

Gadelkareem Rabea Ahmed RA Abdelraouf Ahmed Mahmoud AM El-Taher Ahmed Mohammed AM Ahmed Abdelfattah Ibrahim AI Shalaby Mahmoud Mohamad MM

BMC urology 20230222 1

<h4>Background</h4>Serum creatinine trajectory (SCr-Tr) is a neglected prognostic tool for chronic and acute kidney injury. We aimed to assess the predictors of SCr-Tr during the time-to-nadir and serum creatinine (SCr) normalization rate after drainage, using percutaneous nephrostomy in patients with bilateral malignant ureteral obstruction.<h4>Methods</h4>A prospective non-randomized study was performed on SCr-Tr in patients with bilateral malignant ureteral obstruction from August 2019 to Mar ...[more]

PMID: 36814273

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Project description:BackgroundUreteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort.MethodsCancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated.ResultsA total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration.ConclusionsResonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage.

Project description:IntroductionPrediction of renal recovery after surgical management of feline unilateral ureteral obstruction (UO) is crucial to guide therapeutic decisions, but predictors of this outcome are still lacking. Despite the functional importance of the contralateral kidney, there is currently no precise description of its ultrasonographic (US) features. In addition, US parameters of both the renal collecting system and the renal parenchyma have been identified in human medicine as prognostic factors in the case of UO but have not been described in veterinary medicine. The aim of this study was to evaluate an association between preoperative structural US renal parameters and long-term International Renal Interest Society (IRIS) stage after successful renal decompression with subcutaneous ureteral bypass (SUB) device in cats with unilateral UO.MethodsThis retrospective study included 60 cats with unilateral UO and evaluated preoperative US parameters of both kidneys, including measurements of parenchymal and pelvic areas as well as a renal score. Cats were divided according to their serum creatinine at 3 months postoperatively into group A (IRIS stages I and II) and group B (IRIS stages III and IV).ResultsA higher US chronic kidney disease (US-CKD) score of the kidney contralateral to the UO was associated with long-term IRIS stages III and IV. It also appeared as a fair discriminator of long-term IRIS stage IV, with an area under the curve of 0.74. The optimal cutoff value for accurately identifying cats with long-term IRIS stage IV was a US-CKD score > 7, with a specificity of 98%, a sensitivity of 25%, and a positive likelihood ratio of 12.75. No preoperative US parameters regarding the obstructed kidney, including parenchymal and pelvic areas, were significantly associated with long-term creatinine.ConclusionUltrasonographic scoring of contralateral chronic kidney disease abnormalities is associated with IRIS stage following treatment of feline unilateral UO with a SUB device and serves as a specific indicator of cats presenting with long-term IRIS stage IV.

Dataset Information

Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study.

Background

Methods

Results

Conclusions

Publications

Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study.

Similar Datasets

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