This prospective study from India included 744 patients of whom 112 had renal function less than or equal to 20% at the time of diagnosis. Thirty percent underwent a nephrostomy initially. Ten with no function had a nephrectomy. Of the 102 with remaining kidneys, differential function was 0-9% in 40, 10-20% in 62. Follow-up of one to eight years (mean 4.6 ± 1.34 years) showed significant improvement in drainage in all 96 patients that were available for follow-up. Differential function improved and remained stable in these cases between the initial postoperative three-month renogram and scans up to eight years later. The authors conclude that, whereas previously kidneys with function less than 15-20% were removed rather than having a pyeloplasty performed, their data suggests that nephrectomy should only be considered in children with 0-5% function or, if there is no renal parenchyma of note, if there is pyonephrosis, hypertension or minimal output on nephrostomy drainage. This policy will undoubtedly ‘save’ more kidneys. 

Outcome analysis of pediatric pyeloplasty in units with less than 20% differential function.
Menon P, Rao KL, Bhattacharya A, Mittal BR.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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