The Recovery Condition Of Affected Side Kidney In Upper Urinary Tract Obstruction After Relief Obstruction,a Retrospective Study

Objective:Observe the renal function change of upper urinary tract obstruction after relieving the obstruction of the affected kidney by means of retrospective study,and discuss the recovery condition of the kidneys with different damage degree.And go a further step,make a discussion about that if we can retain these kidneys by the positive treatment,which have been supposed to be resected in the estimation before operation.Methods:This study investigated the affected side GFR change of 78 patients who have been diagnosed definitely with upper urinary tract obstruction after operation 1 month,during January and December of 2015.Including 42 male cases,36 female cases,average age(51.3±12.8)years old,all of them were diagnosed definitely with upper urinary tract stenosis(6 cases)or upper urinary tract calculi(72 cases),and Completed the examination of CT 3d-imaging and ECT before and after operation.Divided all the patients into 3 groups by the decreased degree of affected side kidney before operation,including moderately decreased group[15 ml/min?GFR<30 ml/min,n=43,mean value=(23.1±5.0)ml/min,the mean value of renal cortical thickness(RCT)=(12.5±4.3)mm],severely decreased group [7.5 ml/min?GFR<15 ml/min,n=23,mean value=(11.2±2.3)ml/min,the mean value of RCT=(8.3±3.7)mm],and extreme severely decreased group [GFR<7.5 ml/min,n=12,mean value=(4.3±2.9)ml/min].Measure the renal cortical thickness of 3 different level by CT images.After the agreement of patients,relieved the obstruction by URL,PCNL,FUL,and et al.Observed the recovery condition of each group after pulling out the D-J tube.The follow up time of the extreme severely decreased group extended to 8-12 months.Linear correlation analysis was used in the relationship analysis between the GFR value(pre-operation,post-operation)and the renal cortical thickness.SPSS 19.0 software was used for statistical analysis and Graphpad Prism software was used for mapping.Statistical significance corresponded to p value < 0.05.Results:After operation,the GFR of moderate decreased group recovered to(30.6±8.5)ml/min,regained averagely(7.56±7.62)ml/min,the difference had statistical significance;the severely decreased group recovered to(13.1±4.5)ml/min,regain(1.94±3.38)ml/min,the difference had statistical significance;the former group had better recovery than the latter(P<0.05).In the linear correlation analysis,the relationship of preoperative and postoperative between the renal cortical thickness were non complete linear positive correlation.The correlation coefficient of pre-operation(0.59)was significantly lower than post-operation(0.70),the difference had statistical significance.And the GFR of extreme severely decreased group recovered to(11.1±3.4)ml/min,regained averagely(6.75±4.76)ml/min,the GFR mean value after operation 8-12 months recovered to(12.7±3.6)ml/min,both of them got statistic significance recovery(P<0.05).In this group there were 8 patients whose kidney got recovery to more than 10 ml/min.Conclusion:Most of affected side kidneys got different degree recovery after operation.Obstruction influenced the accuracy of ECT at the time of evaluating the actual renal function before operation.The kidneys which had been supposed to resect in presurgical evaluation could recover to the level of retaining.