An analysis of long-term occurrence of renal complications following pediatric pyeloplasty

Abstract

Objective: Few reports discuss post-pubertal renal complications after pyeloplasty. We analyzed long-term complications, such as decreased renal function (RF) measured by serum creatinine (SCr), hypertension (HTN), or proteinuria (protU) following pediatric pyeloplasty. Subjects and methods: We retrospectively investigated 257 patients who underwent dismembered pyeloplasty due to ureteropelvic junction obstruction from January 1986 to December 2001. Medical history, preoperative and postoperative blood pressure, urinalysis, and SCr results were reviewed. Results: Fifty-five patients (47 male, 8 female) who were followed up for at least 10 years with post-pubertal follow-up data available were analyzed. Seven (12.7%) patients were diagnosed with HTN, and 10 (18.2%) with protU. The grade of hydronephrosis decreased, and the differential RF measured by MAG-3 renal scan significantly increased at final analysis (p < 0.001). Presence of preoperative symptoms (p = 0.034), and SCr elevation (p = 0.018) showed correlation with HTN. HTN took 15.7 (+/- 5.8) (7-25) years, and protU detection took 16.2 (+/- 5.9) (6-23) years, with the highest incidence of both HTN and protU between 15 and 20 years postoperatively. Conclusion: According to our investigation, a prudent evaluation of signs of RF decrease at 10 years after surgery, and then every 5 years, until 20 years should be recommended, although further studies are necessary. (C) 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.