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. 2015 Jul 29;7(4):e28051.
doi: 10.5812/numonthly.28051. eCollection 2015 Jul.

Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction

Kaushal Kumar  1 , Ahsan Ahmad  1 , Shailendra Kumar  1 , Vijyanand Choudhry  2 , Rajesh Kumar Tiwari  1 , Mahendra Singh  1 , Mohammad Ali Muzaffar  1
Affiliations

Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction

Kaushal Kumar et al. Nephrourol Mon. .

Abstract

Background: Pyeloplasty is a widely accepted treatment for ureteropelvic junction obstruction (UPJO). However, the renal function recoverability after pyeloplasty is still a matter of debate. Different parameters have been used to predict renal functional recoverability after corrective surgery, with conflicting results.

Objectives: In this study, renal biopsy was carried on a series of cases of UPJO, during pyeloplasty, to study the extent of histological alterations in renal parenchyma, as a result of obstruction, and its predictive value in renal function recoverability after pyeloplasty.

Patients and methods: We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 53 adult patients. Histopathological changes were graded on a scale of 1 to 3, according to their severity, and compared with the differential renal function (DRF) revealed on the preoperative and postoperative follow up diethylene triamine pentaacetic acid (DTPA) renal scan. A Fischer's t test was used to evaluate statistical differences between values.

Results: This study showed a linear relationship between the severity of histological changes and renal function recovery, after pyeloplasty. Out of 24 obstructed renal units (ORU), with minimal histopathological changes (grade I), 21 ORU (87.5%), with > 35% DRF preoperatively, showed significant improvement in renal function after 12 months of pyeloplasty (P < 0.05). On the other hand, all kidneys (n = 29) with moderate to severe obstructive changes (grade II and III) had minimal improvement in DRF, after pyeloplasty, which was clinically insignificant (P > 0.05). Renal function deterioration after pyeloplasty was not observed in any of the cases.

Conclusions: The severity of pathological changes in renal parenchyma, due to UPJO, is a good predictor of renal function recoverability, after pyeloplasty. The ORUs, with DRF > 35%, usually have normal (grade I) renal biopsy and might be expected to present better functional recoverability after pyeloplasty.

Keywords: Biopsy; Hydronephrosis; Renal Pelvis; Ureteropelvic Junction Obstruction.

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Figures

Figure 1.
Figure 1.. Grade I Histopathological Changes-Normal Tubular and Glomerular Structures
Figure 2.
Figure 2.. Grade 2, Histopathological Changes-Mild Dilatation of Collecting Tubules and Bowen’s Space, Minimal Degree of Inflammation
Figure 3.
Figure 3.. Grade 3, Histopathological Changes-Dysplastic Glomeruli Marked Interstitial Fibrosis, Tubular Atrophy
See this image and copyright information in PMC

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