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28
TH
CONGRESS OF THE ESPU
S6: NEPHROLOGY & RENAL
TRANSPLANTATION
Moderators: Marino Asensio (Spain), Yazan Rawashdeh (Denmark)
ESPU Meeting on Thursday 20, April 2017, 09:32–10:20
09:32–09:35
S6-1 (PP)
PROGNOSTIC FACTORS FOR IMPROVEMENT
IN DRF AFTER PYELOPLASTY FOR PUJO IN INFANTS
AND CHILDREN
Josefin NORDENSTRÖM
1
, Gundela HOLMDAHL
1
, Kate ABRAHAMSSON
1
,
Giasemi KHOUTOZI
2
, Rune SIXT
3
and Sofia SJOSTROM
1
1) The Queen Silvia Children’s Hospital, Dpt of Pediatric Surgery/Urology, Gothenburg, SWEDEN - 2) The Sahlgrenska
University Hospital, Dpt of Radiology, Gothenburg, SWEDEN - 3) The Queen Silvia Children’s Hospital, Dpt
of Physiology, Gothenburg, SWEDEN
PURPOSE
The main indications for surgery for pelviureteric junction obstruction (PUJO) are to preserve or even
improve renal function. We studied differences in differential renal function (DRF) in children who
had surgery for PUJO and looked for prognostic factors predicting improvement after pyeloplasty.
MATERIAL AND METHODS
83 children (61 boys, 22 girls) 0-16 years, who had open surgery for PUJO were followed according
to a structured local protocol including ultrasounds and renal scans (MAG3) pre and postoperatively.
Study data was collected retrospectively. The patients were divided into prenatally (Group 1, n=24)
and postnatally diagnosed (Group 2, n=59). Uni- and multivariable logistic regression analyses
searching factors predicting improvement in DRF included age at diagnosis and surgery, sex, type
of presentation, cause of obstruction, e-GFR, preoperative DRF, APD (mm), calyceal dilatation,
APD/renal parenchymal thickness and grade of hydronephrosis according to Onen (grade 1-4).
RESULTS
Preoperative DRF% on the obstructed side was mean 44% (SD16) with no difference between
groups. Median age at surgery was 0.9 (0.2-10) in Group1 and 8 (0.6-16) in Group 2. The major-
ity (n=52, 72%) had unchanged DRF 18 months postoperatively, 19 (26%) improved > 5% and
one deteriorated. The improvement in DRF was higher in Group 1 (n=10, 46%, p=0.025). APD/
Parenchymal thickness, APD, Preoperative DRF and antenatal diagnosis were predictors in the
univariable analyses and high APD, OR 1.1, p=0.0023, antenatal diagnosis, OR 0.23, p=0.048, and
low preoperative DRF, OR 0.90, p=0.0045 were independent factors predicting >5% improvement
in DRF in the multivariable regression analyses.
CONCLUSIONS
The majority of children had preserved or improved function after surgery for PUJO. The children
with antenatal diagnosis showed greater ability to catch up in DRF and high APD, antenatal diag-
nosis and low preoperative DRF% are predictive factors for improvement of renal function after
pyeloplasty.