May Be A Threshold Value For Differantial Renal Function In Pediatrics With Poor Renal Function?

BACKGROUND: The aim of this study was to evaluate the factors, especially differential renal function (DRF), affecting surgical success in patients with poor renal function associated with ureteropelvic junction obstruction (UPJO). MATERIAL AND METHODS The data of forty-five pediatric patients who underwent pyeloplasty due to a glomerular filtration rate (GFR) of 15 ml/min or lower secondary to UPJO between 2015 and 2022 were analyzed. The procedures were performed by a single surgeon using the Anderson-Hynes pyeloplasty technique. The patients’ age, UPJO laterality, anteroposterior diameter (APD) of the renal pelvis, renal parenchymal thickness (PT), and preoperative and postoperative DRF and GFRs were recorded. In addition, the effects of the renal pelvis APD/PT ratio, renal pelvis APD/US length ratio, and preoperative DRF levels on the procedure's success were evaluated. RESULTS: The data of 29 patients who met the study inclusion criteria were examined. The mean age of the study patients was 48.79 months (5–180 months). The mean GFR and DRF values were 13.44±1.52 ml/min and 28.69%±9.32 in the preoperative period and increased to 23.35±10.52 ml/min and 35.71%±15.04 at postoperative 6 th -months and 24.35±10.8 ml/min and 35.27%±14.57 at postoperative 12 th -months, respectively (p<0.001, p<0.001). A preoperative DRF greater than 18 was identified as a factor affecting success of the surgery (p=0.006). CONCLUSION Different from other studies, the cut-off point for DRF was found to be 18 in patients with a GFR of 15 ml/min or lower and diminished renal functions, supporting the notion that pyeloplasty should be preferred in such patients.