单侧重度肾积水解除梗阻后肾功能恢复不佳的影响因素分析

Analysis of factors influencing poor recovery of renal function after unilateral severe hydronephrosis with relief of obstruction

目的 分析单侧重度肾积水患者解除梗阻后肾功能恢复不佳的影响因素,为预测肾功能恢复提供依据。方法 回顾性分析2015至2022年东莞东华医院收治的55例单侧重度肾积水且肾小球滤过率(GFR)<10 mL/min患者的病例资料,所有患者均采用经皮肾穿刺造瘘临时解除梗阻,根据肾功能的恢复情况分为肾功能恢复组和肾功能未恢复组,收集并分析解除梗阻后肾功能恢复的影响因素。结果 55例重度肾积水行经皮肾造瘘解除梗阻后,30例(54.5%)肾功能恢复,25例(45.5%)肾功能恢复不佳。单因素分析显示,2组患者的性别、患肾侧别、BMI、糖尿病史、高血压病史、造瘘前肾小球滤过率(GFR)、患肾尿液pH值等指标比较差异均无统计学意义(P均>0.05);2组患者的年龄、肾实质厚度、患肾GFR与总GFR比值、肾积水感染状态以及造瘘后患肾尿量比较差异有统计学意义(P <0.05)。多因素Logistic回归分析显示,造瘘前患肾GFR与总GFR比值(OR=0.24,95%CI 0.06~0.98)和造瘘后患肾尿量(OR=0.04,95%CI 0.01~0.25)为造瘘后肾功能恢复的影响因素。结论 GFR<10 mL/min的单侧重度肾积水使用经皮肾造瘘临时解除梗阻后,部分患者的肾功能可恢复;造瘘前患肾GFR与总GFR比值<10%和造瘘后患肾尿量<400 mL/d为患肾功能恢复不佳的影响因素,临床医师可根据患肾造瘘前的GFR与总GFR值和尿量预测患肾功能的恢复情况。

Objective To analyze the factors influencing poor recovery of renal function in patients with severe unilateral hydronephrosis after relief of obstruction,providing evidence for predicting the recovery of renal function.Methods Clinical data of 55 patients with severe unilateral hydronephrosis and glomerular filtration rate(GFR)<10 mL/min admitted to Tungwah Hospital from 2015 to 2022 were retrospectively analyzed.All patients underwent percutaneous nephrostomy for temporary relief of the obstruction.Based on the recovery of renal function,all patients were divided into the recovery group and non-recovery group,and the factors influencing renal function recovery after nephrostomy were collected and analyzed.Results Among 55 patients treated with percutaneous nephrostomy for severe hydronephrosis,renal function was recovered in 30 cases(54.5%),and poor recovery in 25 cases(45.5%).Univariate analysis showed no significant differences in terms of gender,side,body mass index(BMI),history of diabetes mellitus,history of hypertension,pre-nephrostomy GFR,and urinary pH of the affected kidney between the recovery and non-recovery groups(all P>0.05).However,there were significant differences in age,renal parenchymal thickness,ratio of GFR of the affected kidney to total GFR,presence of renal infection,and post-nephrostomy urinary output of the affected kidney between two groups(all P<0.05).Further multivariate logistic regression analysis showed that a pre-nephrostomy ratio of GFR of the affected kidney to total GFR(OR=0.24,95%CI 0.06-0.98)and a post-nephrostomy urinary output of the affected kidney(OR=0.04,95%CI 0.01-0.25)were the independent influencing factors of poor recovery of renal function after nephrostomy.Conclusions Partial patients with severe unilateral hydronephrosis and a GFR<10 mL/min can obtain renal function recovery after temporary relief of obstruction via percutaneous nephrostomy.The pre-nephrostomy ratio of GFR of the affected kidney to total GFR<10%and post-nephrostomy urinary output of the affected kidney<400 mL/day are the independent influencing factors for poor recovery of renal function,which can guide clinicians in predicting renal outcome.