Abstract: FR-PO460
Concomitant Acute Pyelonephritis and Obstruction Duration Affects Renal Outcome in Obstructive Uropathy by Urolithiasis
Session Information
- CKD: Risk Factors for Incidence and Progression - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 301 CKD: Risk Factors for Incidence and Progression
Authors
- Shin, Jung-ho, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
- Jeong, So-hee, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
- Hwang, Jin Ho, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
- Kim, Su Hyun, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
Background
Urolithiasis related obstructive uropathy is one of increasing causes of CKD, which commonly encountered in clinical field. Obstruction release from urolithiasis can be easily delayed with a lack of suggested golden time to prevent renal function deterioration. Here, we investigated the clinical significance and renal outcomes of urolithiasis related obstructive uropathy.
Methods
This is a pilot study of 414 from 2315 patients in urolithiasis related obstructive uropathy cohort which is recruited between Jan. 2005 and Dec. 2015. Clinical outcomes were evaluated with respect to obstruction duration, acute kidney injury (AKI), and acute pyelonephritis (APN) accompanied by obstructive uropathy.
Results
Median duration of obstruction (elapsed time to release obstruction) was 5 days and APN was accompanied in 17.1% of patients. In the patients whose obstruction was relieved within 2 days from the symptom onset, 14.5% showed spontaneous release of obstruction. In the patients with concomitant APN, mean age was older (57.67vs 52.5 years old, P=0.007), estimated GFR (eGFR) at the time of admission was lower (63.5 vs. 79.4 ml/min/1.73m2, P<0.001), and the use of NSAIDs were lower (49.3% vs. 74.9%, P<0.001). The eGFR decrease of >30% from baseline (P<0.001) and eGFR decrease of >50% (P<0.001) occurred significantly more in patients with concomitant APN. The AKI grades by KDIGO showed worse renal outcome in advanced stage (P=0.001). The patients whose obstruction was released within 2 days from the symptom onset, showed more favorable outcome in eGFR decrease of >30% (P=0.019). When we adjusted gender, age, HT, DM, use of NSAIDs, APN, AKI grades, and obstruction release over 2 days for a multivariate analysis, APN (HR 2.2, CI 1.01-4.65; P=0.047) and the obstruction release after 2 days (HR 3.55, CI 1.34-9.38; P=0.011) were independently associated with eGFR decrease of >30%. Concomitant APN was also associated with eGFR decrease of >50% (HR 8.006, CI 1.86-34.38, P=0.005). The use of NSAIDs was associated with favorable renal outcomes.
Conclusion
In urolithiasis related obstructive uropathy patients, concomitant APN was strongly associated with renal function deterioration after obstruction release. The elapsed time to release obstruction also affected to renal function.