Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

Alexandra R Stewart; Stephen W Olson; Brent L Lechner; Maura A Watson; Christina M Yuan; Robert Nee

doi:10.1007/s11255-024-04075-9

Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

Int Urol Nephrol. 2024 May 11. doi: 10.1007/s11255-024-04075-9. Online ahead of print.

Authors

Alexandra R Stewart^{1

2}, Stephen W Olson¹, Brent L Lechner³, Maura A Watson^{1

2}, Christina M Yuan^{1

2}, Robert Nee^{4

5}

Affiliations

¹ Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
² Department of Medicine, Uniformed Services University, Bethesda, MD, USA.
³ Pediatric Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁴ Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA. robert.nee.civ@health.mil.
⁵ Department of Medicine, Uniformed Services University, Bethesda, MD, USA. robert.nee.civ@health.mil.

PMID: 38733501
DOI: 10.1007/s11255-024-04075-9

Abstract

Purpose: To evaluate the impact of surgical intervention on long-term renal outcomes for adult patients with congenital ureteropelvic junction obstruction (UPJO).

Methods: We queried service members diagnosed with UPJO from the United States Military Health System electronic health records from 2005 to 2020. We assessed demographic, laboratory, radiology, surgical intervention, and outcome data. We evaluated the impact of surgical intervention on renal function based on the estimated glomerular filtration rate (eGFR), hypertension (HTN, defined as any prescription for blood pressure [BP] medication and/or average of two BP readings ≥ 130/80 mmHg more than 2 weeks apart), and changes in renal excretory function on radionuclide scans.

Results: We identified 108 individuals diagnosed with congenital UPJO; mean follow-up of 7 years. Mean age at diagnosis was 25 years; 95% male; 69% White, 15% Black. At diagnosis, median BP was 130/78 mmHg and mean eGFR 93 ml/min/1.73m². Subsequently, 85% had pyeloplasty and 23% had stent placement. There were no significant differences in mean eGFR pre- and post-intervention (94 vs. 93 ml/min/1.73m², respectively; p = 0.15) and prevalence of defined HTN (59% vs. 61%, respectively; p = 0.20). Surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p = 0.01) and T½ emptying time (35 min vs. 19 min, p = 0.009). Similar trends occurred with left-sided UPJO but were not significant.

Conclusion: Surgical intervention was not associated with significant differences in the long-term outcomes of kidney function and HTN prevalence in our young adult cohort. However, renal excretory function improved on radionuclide scans.

Keywords: Congenital anomalies of the kidney and urinary tract (CAKUT); Congenital ureteropelvic junction obstruction; Hypertension; Kidney function; Military health system; Pyeloplasty.