Journal of pediatric urology · 2026
Postobstructive diuresis and its biochemical characteristics in children undergoing pyeloplasty for unilateral pelviureteric junction obstruction - a prospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Pokharkar Ashitosh D, Meshram Rohit Bhashkar, Yadav Charu, Gupta Amit, Chadha Rajiv
Аннотация
BACKGROUND: The characteristics of postobstructive diuresis (POD) following relief of unilateral ureteric obstruction (UUO) has been studied in animals, but there is scarcity of literature on translation of these findings in human pediatric patients with unilateral pelviureteric junction obstruction (PUJO) following pyeloplasty.
OBJECTIVE: The primary objective was to assess the biochemical characteristics of the POD from the operated kidney. Our secondary objective was it's clinical implications and identifying predisposing factors.
STUDY DESIGN: A prospective observational study was conducted on pediatric patients who underwent pyeloplasty for unilateral PUJO. Post-operative differential urine output (UO) from the operated kidney (OK) was compared with the normal contralateral kidney (NCK). Patients were divided into two groups: Group-1 with POD [n = 32; 60.4%] and Group-2 without POD [n = 21; 39.6%]. Data was collected for the occurrence of POD, urine biochemistry and postoperative electrolyte derangement requiring nephrology consultation.
RESULTS: POD occurred in Group-1 patients within 48-h after surgery. They had statistically significant lower median renal parenchymal thickness and higher median renal pelvis antero-posterior diameter (APD), differential ratio of kidney size and proportion of grade-4 hydronephrosis (HN) than Group-2 patients. None of the kidneys with PUJO were small in size. The abnormal biochemistry of POD from OK matched with experimental animal studies except the FeK+ excretion which was significantly higher [13,14,15]. Four patients in Group-1 required nephrology consultation for prolonged POD with electrolyte derangement: one concomitant pyelonephritis in NCK and other three with past history of renal injury. Predisposing factors for POD were parenchymal thinning in enlarged kidneys with SFU grade-4 hydronephrosis and higher renal pelvis APD.
DISCUSSION: Urine biochemistry in human pediatric subjects matches animal studies to a large extent except FeK + excretion and suggests compensation by NCK to maintain homeostasis during POD. Besides the predisposing factors in OK, concomitant or pre-existing (subclinical) functional injury to NCK despite normal appearance on preoperative imaging may limit the compensation resulting in electrolyte derangement.
CONCLUSIONS: High UO from OK mainly contributes to POD. Larger hydronephrotic kidneys with parenchymal thinning are more predisposed to POD. Our observations reveal that concomitant or prior subclinical injury to NCK may not be apparent on preoperative imaging and it could be a warning signal to the clinician for occurrence of electrolyte derangement with prolongation of POD and such patients should be monitored closely during post-operative period.
OBJECTIVE: The primary objective was to assess the biochemical characteristics of the POD from the operated kidney. Our secondary objective was it's clinical implications and identifying predisposing factors.
STUDY DESIGN: A prospective observational study was conducted on pediatric patients who underwent pyeloplasty for unilateral PUJO. Post-operative differential urine output (UO) from the operated kidney (OK) was compared with the normal contralateral kidney (NCK). Patients were divided into two groups: Group-1 with POD [n = 32; 60.4%] and Group-2 without POD [n = 21; 39.6%]. Data was collected for the occurrence of POD, urine biochemistry and postoperative electrolyte derangement requiring nephrology consultation.
RESULTS: POD occurred in Group-1 patients within 48-h after surgery. They had statistically significant lower median renal parenchymal thickness and higher median renal pelvis antero-posterior diameter (APD), differential ratio of kidney size and proportion of grade-4 hydronephrosis (HN) than Group-2 patients. None of the kidneys with PUJO were small in size. The abnormal biochemistry of POD from OK matched with experimental animal studies except the FeK+ excretion which was significantly higher [13,14,15]. Four patients in Group-1 required nephrology consultation for prolonged POD with electrolyte derangement: one concomitant pyelonephritis in NCK and other three with past history of renal injury. Predisposing factors for POD were parenchymal thinning in enlarged kidneys with SFU grade-4 hydronephrosis and higher renal pelvis APD.
DISCUSSION: Urine biochemistry in human pediatric subjects matches animal studies to a large extent except FeK + excretion and suggests compensation by NCK to maintain homeostasis during POD. Besides the predisposing factors in OK, concomitant or pre-existing (subclinical) functional injury to NCK despite normal appearance on preoperative imaging may limit the compensation resulting in electrolyte derangement.
CONCLUSIONS: High UO from OK mainly contributes to POD. Larger hydronephrotic kidneys with parenchymal thinning are more predisposed to POD. Our observations reveal that concomitant or prior subclinical injury to NCK may not be apparent on preoperative imaging and it could be a warning signal to the clinician for occurrence of electrolyte derangement with prolongation of POD and such patients should be monitored closely during post-operative period.