Dataset Information

Predictors of nadir serum creatinine after drainage of bilaterally obstructed kidneys due to different etiologies.

ABSTRACT:

Purpose

To identify the predictors of nadir serum creatinine (SCr) after drainage of bilaterally obstructed kidneys (BOKs) by different modes: double-J stent (JJ) versus percutaneous nephrostomy (PCN) and unilateral versus bilateral drainage.

Methods

A prospective non-randomized study was performed on patients with BOKs and raised SCr during December 2019-November 2021. Relevant variables were studied for improvement and non-improvement and for benign and malignant underlying obstructions (BUO and MUO).

Results

This study included 107 patients with BOKs including 68 (63.6%) males and 39 (36.4%) females. After drainage, 86 (80.4%) patients get improved, while 21 (19.6%) patients failed to reach a nadir SCr. Drainage by PCN was significantly higher in MUO, while JJ was significantly higher in BUO (p < 0.001). Also, bilateral drainage was a significant predictor of improvement in MUO (p = 0.03). In contrast, mode of drainage had no significant effect on improvement in BUO (p = 0.84), but bilateral drainage was a significant factor of rapid time to nadir (p = 0.02). Univariate analyses revealed no significant effects on the improvement in SCr from the studied variables, except the male gender (p = 0.01), old age (p < 0.001), MUO (p = 0.01), unilateral drainage (p < 0.001), and use of PCN for drainage (p < 0.001). By multivariate analysis, unilateral drainage (p = 0.01) and MUO (p < 0.001) were independent predictors of non-improvement in patients with BOKs.

Conclusions

Male gender, old age, MUO, unilateral drainage, and drainage by PCN were significant predictors of non-improvement in SCr after drainage of BOKs. However, unilateral drainage and MUO were the only independent predictors of non-improvement.

SUBMITTER: Gadelkareem RA

PROVIDER: S-EPMC9372120 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Predictors of nadir serum creatinine after drainage of bilaterally obstructed kidneys due to different etiologies.

Gadelkareem Rabea Ahmed RA Abdelraouf Ahmed Mahmoud AM El-Taher Ahmed Mohammed AM Ahmed Abdelfattah Ibrahim AI Mohammed Nasreldin N

International urology and nephrology 20220706 9

<h4>Purpose</h4>To identify the predictors of nadir serum creatinine (SCr) after drainage of bilaterally obstructed kidneys (BOKs) by different modes: double-J stent (JJ) versus percutaneous nephrostomy (PCN) and unilateral versus bilateral drainage.<h4>Methods</h4>A prospective non-randomized study was performed on patients with BOKs and raised SCr during December 2019-November 2021. Relevant variables were studied for improvement and non-improvement and for benign and malignant underlying obst ...[more]

PMID: 35794400

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Project description:BackgroundPosterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%-21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding.ObjectiveWe performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs.MethodsWe conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.ResultsA total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35-25.17, I 2 = 92.20%, p < 0.001).ConclusionsNadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.

Project description:ObjectivesACE inhibitors (ACEI) are underutilised despite cardiovascular benefits, in part due to concerns of known transient elevations in serum creatinine (SCr) after initiation. Our objectives were to evaluate rates and predictors of ACEI discontinuation after SCr elevation post-ACEI initiation since limited data are available that examine this issue.SettingPrimary and tertiary Veterans healthcare system in Los Angeles, California, USA PARTICIPANTS: 3039 outpatients initiating an ACEI with a SCr measured within 6?months prior to and approximately 3?months after initiating an ACEI. Patients were divided into three groups (SCr <1.5, 1.5–2 and >2).Primary and secondary outcome measuresRates and factors associated with ACEI discontinuation subsequent to SCr elevation after ACEI initiation and for patients with baseline SCr >2?mg/dL, the change in SCr associated with chronic use. Predictors were identified using multivariate logistic regression modelling.ResultsAt 3?months follow-up, for those with an increase in SCr, the mean increase post-ACEI initiation was 26%, ranging from ?0.01?mg/dL to 0.42?mg/dL varying according to a level of baseline renal function. ACEI discontinuation was higher in patients with elevated baseline SCr (19/165, 11.5%) compared with those with SCr <1.5 (135/2497, 5.4%), and those with SCr 1.5–2.0 (28/377, 7.4%). Male patients, and those with heart failure were less likely to discontinue ACEI after an elevation of SCr post-ACEI initiation, while those taking non-steroidal anti-inflammatory drugs, diuretics and ?-blockers were more likely to discontinue ACEI.ConclusionsSCr increases <30% on average within 3?months of ACEI initiation, with subsequent discontinuation rates varying by baseline SCr. Elevation in SCr was not associated with ACEI discontinuation rates. In patients with SCr >2?mg/dL at baseline, despite an acute increase in SCr after ACEI initiation, chronic ACEI use was associated with a decrease in SCr in most patients.

Dataset Information

Predictors of nadir serum creatinine after drainage of bilaterally obstructed kidneys due to different etiologies.

Purpose

Methods

Results

Conclusions

Publications

Predictors of nadir serum creatinine after drainage of bilaterally obstructed kidneys due to different etiologies.

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