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Abstract: FR-PO182

Concomitant Acute Pyelonephritis and Obstruction Duration Affects Renal Outcome in Obstructive Uropathy by Urolithiasis

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Yeo, Seongyup, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Hwang, Jin Ho, Department of Internal Medicine, 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 study of 1646 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 6 days and APN was accompanied in 14.3% of patients. Patients with HT, DM, and CKD had significantly higher rates of APN accompanied by obstructive uropathy. In the patients whose obstruction was relieved within 2 days from the symptom onset, 8.7% showed spontaneous release of obstruction. There was a significant increase in the number of APN (P=0.008) and AKI (P=0.002) patients who underwent early treatment of obstruction within 6 days from the symptom onset. People with Grade 1 or 2 hydronephrosis tended to release obstruction earlier, and those with Grade 3 or 4 had a higher rate of obstruction release after 7 days. In the patients with concomitant APN, mean age was older (59.4 vs 51.9 years-old, P<0.001), AKI occurred more frequently (73.7% vs 32.9%, P<0.001), estimated GFR (eGFR) at the last follow-up visit was lower (80.9 vs. 86.9 ml/min/1.73m2, P=0.024), and the use of NSAIDs were lower (49.3% vs. 74.9%, P<0.001). The AKI grades by KDIGO showed worse renal outcome in advanced stage (P=0.001). 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%.

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.