Surgical Intervention and Long-Term Renal Outcomes of Congenital Ureteropelvic Junction Obstruction in a Young Adult Cohort

Surgical Intervention and Long-Term Renal Outcomes of Congenital Ureteropelvic Junction Obstruction in a Young Adult Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical Intervention and Long-Term Renal Outcomes of Congenital Ureteropelvic Junction Obstruction in a Young Adult Cohort Alexandra Stewart, Stephen Olson, Brent Lechner, Maura Watson, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4229645/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 May, 2024 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version 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 ≥ 130/80mmHg 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 130/78mmHg and mean eGFR 93ml/min/1.73m 2 . 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/1.73m 2 , 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. Congenital ureteropelvic junction obstruction congenital anomalies of the kidney and urinary tract (CAKUT) hypertension kidney function pyeloplasty Military Health System INTRODUCTION Ureteropelvic junction obstruction (UPJO) is characterized by impaired flow of urine from the renal pelvis to the ureter due to blockage, caused by either acquired or congenital factors, and is the most common cause of antenatal and neonatal hydronephrosis. Congenital UPJO affects 1 in 1000–2000 live births and can be detected at any time, ranging from in utero to old age . Presentation is variable and may include abdominal or back pain, renal calculi, pyelonephritis, impaired renal function, hematuria, and hypertension. In addition, a substantial number of adult patients present with an incidental finding of hydronephrosis on imaging performed for unrelated symptoms . If left untreated, UPJO can lead to interstitial fibrosis, loss of nephrons and ultimately kidney failure 1 . Thus, early diagnosis and prompt treatment is paramount. The goals of surgical interventions are to improve renal drainage, renal function and clinical symptoms. Current literature on congenital UPJO has predominantly focused on the pediatric population with most follow-up ceasing prior to reaching adulthood , , , . Most studies of adult UPJO evaluated short-term surgical outcomes, had follow-up duration < 2 years, or focused on poorly functioning kidneys (defined radiographically) , , , , . In a single-center study, Elbaset et al retrospectively evaluated renal function after pyeloplasty in adults with unilateral UPJO and poorly functioning kidneys (mean preoperative GFR 15 ml/min) and found significant increase in differential renal function (DRF, from 20.5 to 23.5%, p < 0.0001) after a mean follow-up of 67 months. However, there were no data on blood pressure (BP) outcomes. Another retrospective analysis of 49 adults showed significant reduction in BP (mean arterial pressure, -9mmHg; 95% confidence interval 6–12) after surgical relief of UPJO. However, only a few patients in this study had follow-up data > 12 months, and long-term renal function by estimated glomerular filtration rate (eGFR) was not assessed . Two recent retrospective studies of adults with UPJO evaluated renal function and radiographic outcomes although median follow-up was less than 2 years , . In this study, we sought to assess the long-term renal and BP outcomes after surgical intervention in a large, racially diverse, young adult patient population with congenital UPJO in a global healthcare system. We hypothesized that surgical correction would associate with improved renal excretory function on radionuclide scans, long-term stabilization of eGFR and lower risk of hypertension (HTN). MATERIAL AND METHODS We conducted a retrospective cohort study using data from the United States Military Health System (MHS), composed of 9.6 million active and retired service members and their families . This integrated health system allows its beneficiaries to be followed longitudinally, regardless of location. The global health network includes 65 hospitals and 412 clinics. The majority of these locations began to use a universal electronic health record (EHR) in 2005. We queried this EHR for UPJO, using International Classification of Diseases, 9th Ed (ICD-9) and 10th Ed (ICD-10) codes between 2005 and 2020. We initiated our query using keywords “congenital”, “ureter”, “kidney”, and “renal” to find associated diagnostic codes for congenital UPJO. We then narrowed the codes (ICD-9: 753.21; ICD-10: N13x; ICD-10: Q62x) for our initial cohort followed by chart review to confirm the clinical diagnosis of “congenital obstruction of ureteropelvic junction.” Our cohort consisted of current and prior active-duty service members, aged 18 to 64, as well as pediatric (< 18 years) beneficiaries at the time of UPJO diagnosis who later became active-duty service members meeting adult-aged criteria for inclusion in the study. Of note, individuals entering active-duty service must undergo medical screening which includes a self-reported health history, BP, physical examination, and dipstick urinalysis. Although serum creatinine and quantitative albuminuria are not routinely performed as part of the screening process, findings of proteinuria/hematuria on dipstick may preclude service enlistment. We conducted a comprehensive review of the EHR for each patient with congenital UPJO. Patients were excluded if documentation or imaging studies suggest a secondary, acquired cause for obstruction. Other exclusion criteria included history of horseshoe anomaly or any systemic disorder that could cause renal impairment (diabetes mellitus, resistant hypertension, and cardiovascular disease). Patients that did not have follow-up data after surgical procedure were also excluded. We obtained data on demographics to include self-reported race, comorbidities, history of recurrent urinary tract infections (self-reported or history of positive urine culture), medications, family history, vital signs, laboratory to include serum creatinine and presence of proteinuria (defined as protein ≥ 1 + or ≥ 30 mg/dl on urinalysis without presence of infection), radiology, and surgical procedures performed (open, robotic or laparoscopic pyeloplasty; stenting; and nephrectomy). We then assessed the association of surgical intervention with changes in eGFR, calculated by the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation that does not include the race term . Specifically, we obtained data on creatinine measurements at the time of UPJO diagnosis (pre-surgical intervention) and during last follow-up (post-surgical intervention). We also assessed the association of surgical intervention on BP and prevalence of HTN, defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic ≥ 130mmHg or average diastolic ≥ 80mmHg . Lastly, we evaluated changes in kidney size on ultrasound study, and renal excretory function on radionuclide scans. DRF and T½ emptying time were evaluated by diuretic (furosemide) renography using the radioisotope Tc-99MAG3. Renal cortical excretion was classified as normal or delayed by the interpreting radiologist, the latter defined as T1/2 emptying time of greater than 20 minutes. Analyses were performed with Chi-square testing for categorical variables (McNemar test for paired proportions) and Student's t- test for continuous variables (paired t -tests for paired observations). A p-value < 0.05 was considered statistically significant. Analyses were performed using Stata MP/16.1 (College Station, Tx). The protocol for our study (#930510) was approved by the Walter Reed National Military Medical Center Institutional Review Board. RESULTS We identified 108 individuals diagnosed with congenital UPJO with a mean follow-up of 7 years ± 6.6 (Table 1 ). The mean age at diagnosis was 25 years ± 9 (n = 10 < 18 years; n = 98 ≥ 18 years); 95% male; 69% White, 15% Black, 3% Asian and 12% Other race. Thirty-two (32%) smoked tobacco and 8% had a fami1y history of kidney disease (defined as a reported history of CKD, end-stage kidney disease, or known congenital anomalies of the kidney and urinary tract [CAKUT]). Thirty-two (32%) of patients had a crossing vessel which could cause an extrinsic compression of the ureteropelvic junction, and < 1% had other CAKUT conditions present. Twenty-two (22%) had history of renal calculi pre-pyeloplasty (without concomitant obstruction); 27% had renal calculi post-pyeloplasty. Approximately 7% had a history of recurrent urinary tract infections, defined as ≥ 2 infections within 6 months or ≥ 3 infections within 12 months. Six (6%) had history of pyelonephritis but was not present at time of UPJO. Fifty-five (55%) had right-sided, 40% left-sided and 6% bilateral UPJO. At diagnosis, 80% presented with abdominal/flank pain. Overall, median BP at diagnosis was 130/78 mmHg and 7% of the study cohort were taking antihypertensive drugs (vs. 24% at last follow-up). Among those with available data on BP readings (n = 81), 60% had defined HTN (based on BP medication use and/or average of 2 BP readings ≥ 130/80mmHg) prior to UPJO diagnosis. Mean body mass index at diagnosis was 28 kg/m 2 . Mean serum creatinine at diagnosis was 1.1mg/dl (mean eGFR 93ml/min/1.73m 2 ); and 22% had proteinuria ≥ 30mg/dL on urinalysis. Compared to patients who did not receive surgical management, those who did were significantly more likely to have crossing vessels (7% vs. 36%, respectively) and abdominal/flank pain (57% vs. 83%, respectively). Otherwise, the 2 groups were comparable at baseline. As shown in Table 2 , 87% had undergone at least one procedure (pyeloplasty and/or stent), thus 13% did not have any surgical intervention. Eighty-five (85%) had pyeloplasty and 23% underwent stent procedure; only 2 out of 107 (1.8%) patients had stenting procedure without pyeloplasty. Due to refractory pain or non-functional kidney, 16/108 (15%) of patients underwent nephrectomy, with a substantially greater percentage occurred in those who did not have pyeloplasty (9/14 [64%] in the non-intervention group vs. 7/94 [7%] in the intervention group; p < 0.001). For those who underwent intervention (Table 3 A), the mean eGFR at diagnosis (pre-intervention) and last follow-up (post-intervention) were 94 and 93ml/min/1.73m 2 , respectively (p = 0.15). Ultimately, 54% of the intervention group had eGFR ≥ 90ml/min/1.73m 2 ; 43% had eGFR ≥ 60 and < 90; and only 3% had eGFR ≥ 30 and < 60. Systolic BP decreased significantly with pyeloplasty (131mmHg pre vs. 125mmHg post, p < 0.001), but there was no change in diastolic BP (78mmHg pre vs. 78mmHg post, p = 0.20). There was no significant difference in defined HTN pre- and post-intervention (59% pre vs. 61% post, p = 0.20). For the non-intervention group, there were no significant differences in the initial and final parameters in eGFR, BP and defined HTN. Moreover, there were no significant differences in eGFR, BP and defined HTN between the intervention vs. non-intervention group (Table 3 B). As shown in Table 4 , intervention of 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 minutes pre vs. 19 minutes post, p = 0.009). Similar trends occurred with left-sided UPJO but were not significant (delayed cortical excretion, 59% pre vs. 44% post, p = 0.09; T½ emptying time, 25 minutes pre vs. 24 minutes post, p = 0.77). There were no significant differences in DRF or kidney size pre- and post-procedure for either left-sided or right-sided UPJO. DISCUSSION Using EHR data from the MHS that spanned from 2005–2020, we identified 108 service members with congenital UPJO with a mean follow-up of 7 years. The mean age at diagnosis was 25 years, with the majority consisted of White males. Most patients (87%) underwent at least one procedure (predominantly pyeloplasty), and 15% of patients subsequently had nephrectomy with a substantially greater percentage occurred in those who did not undergo pyeloplasty. With few exceptions, the surgical intervention group had comparable baseline characteristics as the non-intervention group. A high proportion (60%) of the study cohort met our definition of HTN (based on BP medication use and/or average of 2 BP readings ≥ 130/80mmHg) prior to UPJO diagnosis. Potential explanations include: 1) hydronephrosis due to UPJO may lead to the development of HTN; 2) historically higher BP thresholds for pharmacologic treatment (≥ 140/90mmHg); thus our young adult patients with BP ≥ 130/80mmHg during the 15-year study period may not be aggressively treated, consistently with our finding that only 7% were prescribed BP medications at UJPO diagnosis; 3) almost all of the study patients (98%) were taking nonsteroidal anti-inflammatory drugs (NSAIDs) which can increase BP; 4) 25% of the study cohort did not have available EHR data on BP readings prior to UPJO diagnosis which may bias the results. This high prevalence of defined HTN persisted after surgical intervention. Nonetheless, the systolic BP significantly decreased from 131mmHg to 125mmHg post-intervention, although this reduction in BP could be confounded by pharmacologic treatment, since 22% of the intervention group were prescribed BP medications at last follow-up. The diastolic BP remained unchanged. Currently there are no large randomized clinical trials investigating the long-term impact on BP following surgical intervention. Experimental animal studies and small prospective studies, mainly in children, have associated hydronephrosis with elevated BP which could be reduced by surgical management of the obstruction. In our adult study, there was no significant difference in the prevalence of defined HTN pre- and post-intervention. In contrast, a retrospective analysis of 49 adults with congenital UPJO (not on antihypertensive medications) showed improvement in both systolic and diastolic BP after surgical intervention; however, these findings were based predominantly on data ≤ 12 months after relief of obstruction 13 . For our non-intervention group, there were no significant differences between the initial and follow-up measures of defined HTN and median BP. Overall, the mean serum creatinine in our cohort was 1.1 mg/dL at diagnosis (mean eGFR 93ml/min/1.73m 2 ). There was no significant difference between the eGFR pre-intervention (at diagnosis) vs. post-intervention (7 years after diagnosis). However, based on our findings, it would not be valid to conclude that surgical intervention does not favorably alter the longstanding kidney function trajectory. Our cohort consisted of young adults with minimal comorbidities and preserved kidney function at baseline. And studies with even longer follow-up periods (> 10 years) would be required to detect any differences in eGFR outcome between the intervention and non-intervention group. Almost all (97%) of the patients in the intervention group maintained a robust kidney function (eGFR ≥ 60 ml/min/1.73m 2 ) at last follow up. There is a paucity of literature examining long-term risk of CKD in adults with congenital UPJO. In an adult cohort with UPJO and advanced CKD, Elbaset et al 12 reported an improvement in eGFR from 15 ± 6 ml/min to 23 ± 10 ml/min after pyeloplasty. However, their cohort characteristics differed substantially from our active-duty cohort (e.g. poor baseline kidney function; >50% of their cohort had positive urine culture). In another study of adult patients with UPJO, there was no significant changes in eGFR after pyeloplasty (68ml/min vs. 80ml/min; p = 0.93) among those with pre-operative DRF ≤ 15%; however, eGFR significantly increased from 93 to 101ml/min (p = 0.005) among those with DRF > 15% 14 . For our non-pyeloplasty group, there was no significant change in eGFR at last follow-up. Caution is warranted in interpreting this finding, considering the high proportion of patients in this group who required nephrectomy. The maintenance of eGFR over the study period likely reflects glomerular hyperfiltration and compensatory hypertrophy which mask the underlying reduced nephron mass, by potentially returning the total eGFR to approximately 85% of baseline after unilateral nephrectomy. Kasiske BL et alreported an increase in measured GFR by 1.47 ml/min/year between 6 and 36 months after living kidney donation compared to an age-related decline by 0.36 ml/min/year in paired healthy nondonors. In our study, there were no significant differences in DRF and kidney size pre- and post-intervention for either left-sided or right-sided UPJO. However, surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion and decreased T½ emptying time. Similar trends occurred with left-sided UPJO but were not statistically significant likely due to the smaller sample size. Our findings are consistent with a retrospective study by Sivaraman et alwho reported that 97.6% of their adult cohort with UPJO had improved T½ emptying time post-pyeloplasty. Two other small retrospective studies evaluated pre- and post-operative DRF and eGFR but did not report differences in right-sided vs left-sided UPJO , . Our study has certain limitations. Due to the active-duty population in the MHS, most of the study patients were male which may impact the generalizability of our findings. As a comparison, a recent population-based study based on the Optum Clinformatics database showed that 70% of the UPJO cases were male. Also, since all active-duty service members are required to have a medical screening prior to enlistment, a selection bias may occur such that healthier patients with more mild renal manifestations were included in the study cohort. The proportion of patients who underwent radionuclide scan both before and after surgical intervention was relatively small, which may explain the lack of significance in excretory function for left sided UPJO. Some of the study subjects may receive their care at civilian facilities, outside of the MHS, thus we may not have captured all cases of congenital UPJO. Lastly, we cannot draw conclusions about causality given the retrospective nature of our study. However, our study also has unique strengths. The universal EHR in the MHS allowed us to obtain comprehensive and granular clinical data in an integrated and global healthcare system. Our patient cohort included all degrees of clinically significant obstruction, number and surgical techniques of pyeloplasty, and long-term outcomes regarding BP, renal excretory function, and kidney function estimated by the 2021 CKD-EPI creatinine equation. Moreover, our large study cohort is racially diverse with a substantially longer follow-up period than prior studies. Therefore, our study findings narrow the important knowledge gap on renal outcomes in the young adult population with congenital UPJO. In this large cohort of young (predominantly male) adults with congenital UPJO, we found that surgical intervention was not associated with significant differences in the subsequent prevalence of HTN and level of kidney function over the long term; however, renal excretory function improved on radionuclide scans. Further studies are greatly needed to assess the long-term BP and renal outcomes of surgical intervention in adults with congenital UPJO to determine the appropriate follow-up medical management for this patient population. Statements and Declarations The authors have no relevant financial or non-financial interests, or conflicts of interests. No funding was received for conducting this study. Disclaimer : The views expressed in this manuscript are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government. Stephen W. Olson, MD is currently an employee of Novartis Pharmaceuticals. Acknowledgements : We would like to acknowledge Sarah Khan, MD, Erin Parker, MD, and John Thurlow, MD for their contributions to this study. We also appreciate the advice from our urology colleagues, Thomas Gerald, MD and Brock Boehm, MD. Author Contributions : Conceptualization: ARS, SWO, RN; Methodology: ARS, SWO, BLL, MAW, CMY, RN; Formal analysis and investigation: ARS, SWO, RN; Writing-original draft preparation: ARS, RN; Writing-review and editing: ARS, SWO, BLL, MAW, CMY, RN; Supervision: RN References Khan F, Ahmed K, Lee N, Challacombe B, Khan MS, Dasgupta P. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol. 2014 Nov;11(11):629-38. doi: 10.1038/nrurol.2014.240. Epub 2014 Oct 7. PMID: 25287785. 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Tables Table 1 Baseline demographic and clinical characteristics of the cohort at diagnosis of congenital ureteropelvic junction obstruction Variables All (n = 108) Intervention Group (n = 94) Non-Intervention Group (n = 14) P-value Age, mean ± SD (years) 25.4 ± 8.8 25.1 ± 8.9 27.6 ± 7.9 0.33 Male sex 103/108 (95.4) 89/94 (94.7) 14/14 (100) 0.38 Race group 0.35 White 68/99 (68.7) 62/87 (71.3) 6/12 (50) Black 15/99 (15.2) 11/87 (12.6) 4/12 (33.3) Asian 3/99 (3.0) 3/87 (3.4) 0/12 (0) Native American 1/99 (1.0) 1/87 (1.2) 0/12 (0) Other 12/99 (12.1) 10/87 (11.5) 2/12 (16.7) History of hypertension 1 49/81 (60.5) 41/70 (58.6) 8/11 (72.7) 0.37 Antihypertensive drugs At diagnosis 7/108 (6.5) 6/94 (6.4) 1/14 (7.1) 0.91 At last follow-up 26/108 (24.1) 21/94 (22.3) 5/14 (35.7) 0.28 NSAID use 100/102 (98.0) 88/89 (99) 12/13 (92.3) 0.11 Statin use 3/108 (2.8) 3/94 (3.2) 0/14 (0) 0.50 Tobacco use 35/108 (32.4) 29/94 (30.8) 6/14 (42.9) 0.37 Illicit drug use 3/108 (2.8) 3/94 (3.2) 0/14 (0) 0.50 Family history of kidney disease 9/107 (8.4) 8/93 (8.6) 1/14 (7.1) 0.85 Crossing vessel present 35/108 (32.4) 34/94 (36.2) 1/14 (7.1) 0.03 Other CAKUT present 1/108 (0.9) 1/94 (1.1) 0/14 (0) 0.70 Renal calculi present 24/108 (22.2) 21/94 (22.3) 3/14 (21.4) 0.94 History of recurrent urinary tract infections 2 7/108 (6.5) 6/94 (6.4) 1/14 (7.1) 0.91 History of pyelonephritis 6/108 (5.6) 5/94 (5.3) 1/14 (7.1) 0.78 Abdominal/flank pain 86/108 (79.6) 78/94 (83.0) 8/14 (57.1) 0.02 Laterality of obstruction 0.92 Right-sided 59/108 (54.6) 52/94 (55.3) 7/14 (50) Left-sided 43/108 (39.8) 37/94 (39.4) 6/14 (42.9) Bilateral 6/108 (5.6) 5/94 (5.3) 1/14 (7.1) Body mass index, mean ± SD (kg/m 2 ) 27.8 ± 4.1 28.0 ± 4.2 26.5 ± 3.7 0.21 Systolic Blood pressure, median (IQR) Before diagnosis (n = 82) 126 (121–131) 126 (121–131) 127 (118–134) 0.81 At diagnosis (n = 96) 130 (122–138) 131 (122–138) 129 (120–134) 0.58 Diastolic Blood pressure, median (IQR) Before diagnosis (n = 82) 76 (69–81) 75 (68–81) 79 (69–84) 0.21 At diagnosis (n = 96) 78 (70–84) 78 (70–84) 80 (73–87) 0.31 HgbA1C, mean ± SD (%), (n = 34) 5.4 ± 0.6 5.4 ± 0.7 5.6 ± 0.4 0.46 Serum creatinine at diagnosis, mean ± SD (mg/dL) (n = 97) 1.14 ± 0.25 1.14 ± 0.26 1.21 ± 0.20 0.35 eGFR at diagnosis, mean ± SD (ml/min/1.73m 2 ) (n = 97) 93 ± 20.3 94 ± 20.5 87 ± 18.7 0.23 Protein on urinalysis at diagnosis 0.98 0 mg/dL 75/96 (78.1) 65/84 (77.4) 10/12 (83.3) 30 mg/dL 11/96 (11.5) 10/84 (11.9) 1/12 (8.3) ≥50 mg/dL 10/96 (10.4) 9/84 (10.7) 1/12 (8.3) Data are expressed as n/N (%), unless otherwise indicated 1 Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic ≥ 130mmHg or average diastolic ≥ 80mmHg 2 Recurrent urinary tract infections are defined as ≥ 2 infections within 6 months or ≥ 3 infections within 12 months ACE inhibitor: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blockers; NSAID: nonsteroidal anti-inflammatory drugs; CAKUT: congenital anomalies of the kidney and urinary tract; HgbA1C: glycated hemoglobin A1C; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation; IQR: interquartile range; SD: standard deviation Table 2 Surgical intervention for congenital ureteropelvic junction obstruction Variables All (n = 108) Pyeloplasty (open, robotic or laparoscopic) 92/108 (85.2) 0 16/108 (14.8) 1 80/108 (74.1) >1 12/108 (11.1) Stent placement 25/107 (23.4) 0 82/107 (74.6) 1 22/107 (20.6) >1 3/107 (2.8) Total procedures (pyeloplasty and/or stent placement) 94/108 (87.0) 0 14/108 (13.0) 1 64/108 (59.3) 2 20/108 (18.5) >2 10/108 (9.3) Nephrectomy 16/108 (14.8) Data are expressed as n/N (%) Table 3 A: Renal function and blood pressure outcomes in congenital ureteropelvic junction obstruction, within-group comparisons Intervention Group P-value 1 Non-Intervention Group P-value 1 Hypertension 2 , n/N (%) Pre-UPJO diagnosis 41/70 (58.6) 0.20 8/11 (72.7) 0.32 At last follow-up 57/94 (60.6) 11/14 (78.6) Blood Pressure, median (IQR) Systolic At diagnosis (n = 96) 131 (122–138) < 0.001 129 (120–134) 0.25 At last follow-up (n = 108) 125 (120–130) 124 (121–128) Diastolic At diagnosis (n = 96) 78 (70–84) 0.20 80 (73–87) 0.85 At last follow-up (n = 108) 78 (73–84) 82 (80–85) eGFR, mean ± SD (ml/min/1.73m 2 ) At diagnosis (n = 97) 94 ± 20.5 0.15 87 ± 18.7 0.84 At last follow-up (n = 107) 93 ± 20.8 86 ± 16.8 1 McNemar test for paired proportions and paired t -tests for paired continuous observations 2 Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic ≥ 130mmHg or average diastolic ≥ 80mmHg UPJO: ureteropelvic junction obstruction; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation Table 3 B: Renal function and blood pressure outcomes in congenital ureteropelvic junction obstruction, between-group comparisons Intervention Group Non-Intervention Group P-value Hypertension 1 , n/N (%) Pre-UPJO diagnosis 41/70 (58.6) 8/11 (72.7) 0.37 At last follow-up 57/94 (60.6) 11/14 (78.6) 0.20 Blood Pressure, median (IQR) Systolic At diagnosis (n = 96) 131 (122–138) 129 (120–134) 0.58 At last follow-up (n = 108) 125 (120–130) 124 (121–128) 0.65 Diastolic At diagnosis (n = 96) 78 (70–84) 80 (73–87) 0.31 At last follow-up (n = 108) 78 (73–84) 82 (80–85) 0.20 eGFR, mean ± SD (ml/min/1.73m 2 ) At diagnosis (n = 97) 94 ± 20.5 87 ± 18.7 0.23 At last follow-up (n = 107) 93 ± 20.8 86 ± 16.8 0.24 1 Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic ≥ 130mmHg or average diastolic ≥ 80mmHg UPJO: ureteropelvic junction obstruction; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation Table 4 Kidney size and renal excretory function in congenital ureteropelvic junction obstruction before and after surgical intervention Variables Pre- Intervention Post- Intervention P-value 1 Left-sided UPJ obstruction Kidney size (ultrasound), cm (n = 7) 13.4 13.0 0.26 Differential function (%) (n = 31) 41.7 40.2 0.45 Delayed cortical excretion, n/N (%) 17/29 (59%) 12/27 (44%) 0.09 T½ emptying time (Lasix scan), min (n = 26) 25.3 23.9 0.77 Right-sided UPJ obstruction Kidney size (ultrasound), cm (n = 10) 13.2 12.1 0.06 Differential function (%) (n = 37) 37.8 39.0 0.13 Delayed cortical excretion, n/N (%) 20/37 (54%) 14/40 (35%) 0.01 T½ emptying time (Lasix scan), min (n = 29) 34.6 19.4 0.009 1 McNemar test for paired proportions and paired t -tests for paired continuous observations UPJ: ureteropelvic junction Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4229645","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":290300132,"identity":"2de25586-a13c-4249-8f17-d5ea5fdafa6d","order_by":0,"name":"Alexandra Stewart","email":"","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alexandra","middleName":"","lastName":"Stewart","suffix":""},{"id":290300133,"identity":"09d033e6-0ee4-4fa9-94cf-1e2ea3ca5951","order_by":1,"name":"Stephen Olson","email":"","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Stephen","middleName":"","lastName":"Olson","suffix":""},{"id":290300134,"identity":"3a0cb136-fbb5-4590-9178-7d789ad640ca","order_by":2,"name":"Brent Lechner","email":"","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Brent","middleName":"","lastName":"Lechner","suffix":""},{"id":290300135,"identity":"d3de337b-77b5-42b8-8df1-1a8a07acf559","order_by":3,"name":"Maura Watson","email":"","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maura","middleName":"","lastName":"Watson","suffix":""},{"id":290300136,"identity":"210c35a8-62a5-48b0-bbfb-2f5a6fd7f125","order_by":4,"name":"Christina Yuan","email":"","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Christina","middleName":"","lastName":"Yuan","suffix":""},{"id":290300137,"identity":"998c759a-15d2-40b2-849c-df5701ba81f5","order_by":5,"name":"Robert Nee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYFACHiR2AoNNAgMDcwMzSJwPr5YEuJY0IJOxsRkkzkaUFgaGw3AtDLi0mLf3Hnxc+YMhj5+9gfHDw7bzQMbB9scFDNtkcGmROXMu2fBMAkOxZM8BZonEtttARmJj8wyG2zgdJiGRYybZkMCQuOFGAhtDwpnbiRsOALXw4Ndi/hOkZf/9ByAt5xL3n39IUIsZI9gWCaB/EyoOABmEbOE5lyzZkCaROONMYrNEQkVy4owbDxtn8xjg0cLee/Bjg41NYn/74YMffxjYJfb3Jx/4zFNx254fhxaYTiBmbEASMMCvfhSMglEwCkYBfgAAvIJXVsqC6sUAAAAASUVORK5CYII=","orcid":"","institution":"Walter Reed National Military Medical Center","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Nee","suffix":""}],"badges":[],"createdAt":"2024-04-07 04:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4229645/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4229645/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-024-04075-9","type":"published","date":"2024-05-11T21:17:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56488062,"identity":"a5f5b46d-26cd-4b94-9c98-c085a82ac80b","added_by":"auto","created_at":"2024-05-14 21:27:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656307,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4229645/v1/481a7115-cfa6-46e7-b174-5b7471242f0b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical Intervention and Long-Term Renal Outcomes of Congenital Ureteropelvic Junction Obstruction in a Young Adult Cohort","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eUreteropelvic junction obstruction (UPJO) is characterized by impaired flow of urine from the renal pelvis to the ureter due to blockage, caused by either acquired or congenital factors, and is the most common cause of antenatal and neonatal hydronephrosis. Congenital UPJO affects 1 in 1000\u0026ndash;2000 live births and can be detected at any time, ranging from \u003cem\u003ein utero\u003c/em\u003e to old age\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e. Presentation is variable and may include abdominal or back pain, renal calculi, pyelonephritis, impaired renal function, hematuria, and hypertension. In addition, a substantial number of adult patients present with an incidental finding of hydronephrosis on imaging performed for unrelated symptoms\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e. If left untreated, UPJO can lead to interstitial fibrosis, loss of nephrons and ultimately kidney failure\u003csup\u003e1\u003c/sup\u003e. Thus, early diagnosis and prompt treatment is paramount. The goals of surgical interventions are to improve renal drainage, renal function and clinical symptoms.\u003c/p\u003e \u003cp\u003eCurrent literature on congenital UPJO has predominantly focused on the pediatric population with most follow-up ceasing prior to reaching adulthood\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e. Most studies of adult UPJO evaluated short-term surgical outcomes, had follow-up duration\u0026thinsp;\u0026lt;\u0026thinsp;2 years, or focused on poorly functioning kidneys (defined radiographically)\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e. In a single-center study, Elbaset et al\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e retrospectively evaluated renal function after pyeloplasty in adults with unilateral UPJO and poorly functioning kidneys (mean preoperative GFR 15 ml/min) and found significant increase in differential renal function (DRF, from 20.5 to 23.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) after a mean follow-up of 67 months. However, there were no data on blood pressure (BP) outcomes. Another retrospective analysis of 49 adults showed significant reduction in BP (mean arterial pressure, -9mmHg; 95% confidence interval 6\u0026ndash;12) after surgical relief of UPJO. However, only a few patients in this study had follow-up data\u0026thinsp;\u0026gt;\u0026thinsp;12 months, and long-term renal function by estimated glomerular filtration rate (eGFR) was not assessed\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e. Two recent retrospective studies of adults with UPJO evaluated renal function and radiographic outcomes although median follow-up was less than 2 years\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e\u003csup\u003e,\u003c/sup\u003e\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e. In this study, we sought to assess the long-term renal and BP outcomes after surgical intervention in a large, racially diverse, young adult patient population with congenital UPJO in a global healthcare system. We hypothesized that surgical correction would associate with improved renal excretory function on radionuclide scans, long-term stabilization of eGFR and lower risk of hypertension (HTN).\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eWe conducted a retrospective cohort study using data from the United States Military Health System (MHS), composed of 9.6\u0026nbsp;million active and retired service members and their families\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e. This integrated health system allows its beneficiaries to be followed longitudinally, regardless of location. The global health network includes 65 hospitals and 412 clinics. The majority of these locations began to use a universal electronic health record (EHR) in 2005. We queried this EHR for UPJO, using International Classification of Diseases, 9th Ed (ICD-9) and 10th Ed (ICD-10) codes between 2005 and 2020. We initiated our query using keywords \u0026ldquo;congenital\u0026rdquo;, \u0026ldquo;ureter\u0026rdquo;, \u0026ldquo;kidney\u0026rdquo;, and \u0026ldquo;renal\u0026rdquo; to find associated diagnostic codes for congenital UPJO. We then narrowed the codes (ICD-9: 753.21; ICD-10: N13x; ICD-10: Q62x) for our initial cohort followed by chart review to confirm the clinical diagnosis of \u0026ldquo;congenital obstruction of ureteropelvic junction.\u0026rdquo; Our cohort consisted of current and prior active-duty service members, aged 18 to 64, as well as pediatric (\u0026lt;\u0026thinsp;18 years) beneficiaries at the time of UPJO diagnosis who later became active-duty service members meeting adult-aged criteria for inclusion in the study. Of note, individuals entering active-duty service must undergo medical screening which includes a self-reported health history, BP, physical examination, and dipstick urinalysis. Although serum creatinine and quantitative albuminuria are not routinely performed as part of the screening process, findings of proteinuria/hematuria on dipstick may preclude service enlistment. We conducted a comprehensive review of the EHR for each patient with congenital UPJO. Patients were excluded if documentation or imaging studies suggest a secondary, acquired cause for obstruction. Other exclusion criteria included history of horseshoe anomaly or any systemic disorder that could cause renal impairment (diabetes mellitus, resistant hypertension, and cardiovascular disease). Patients that did not have follow-up data after surgical procedure were also excluded.\u003c/p\u003e \u003cp\u003eWe obtained data on demographics to include self-reported race, comorbidities, history of recurrent urinary tract infections (self-reported or history of positive urine culture), medications, family history, vital signs, laboratory to include serum creatinine and presence of proteinuria (defined as protein\u0026thinsp;\u0026ge;\u0026thinsp;1\u0026thinsp;+\u0026thinsp;or \u0026ge;\u0026thinsp;30 mg/dl on urinalysis without presence of infection), radiology, and surgical procedures performed (open, robotic or laparoscopic pyeloplasty; stenting; and nephrectomy). We then assessed the association of surgical intervention with changes in eGFR, calculated by the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation that does not include the race term\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e. Specifically, we obtained data on creatinine measurements at the time of UPJO diagnosis (pre-surgical intervention) and during last follow-up (post-surgical intervention). We also assessed the association of surgical intervention on BP and prevalence of HTN, defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic\u0026thinsp;\u0026ge;\u0026thinsp;130mmHg or average diastolic\u0026thinsp;\u0026ge;\u0026thinsp;80mmHg\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003e. Lastly, we evaluated changes in kidney size on ultrasound study, and renal excretory function on radionuclide scans. DRF and T\u0026frac12; emptying time were evaluated by diuretic (furosemide) renography using the radioisotope Tc-99MAG3. Renal cortical excretion was classified as normal or delayed by the interpreting radiologist, the latter defined as T1/2 emptying time of greater than 20 minutes.\u003c/p\u003e \u003cp\u003eAnalyses were performed with Chi-square testing for categorical variables (McNemar test for paired proportions) and Student's \u003cem\u003et-\u003c/em\u003etest for continuous variables (paired \u003cem\u003et\u003c/em\u003e-tests for paired observations). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Analyses were performed using Stata MP/16.1 (College Station, Tx).\u003c/p\u003e \u003cp\u003e The protocol for our study (#930510) was approved by the Walter Reed National Military Medical Center Institutional Review Board.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe identified 108 individuals diagnosed with congenital UPJO with a mean follow-up of 7 years\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age at diagnosis was 25 years\u0026thinsp;\u0026plusmn;\u0026thinsp;9 (n\u0026thinsp;=\u0026thinsp;10\u0026thinsp;\u0026lt;\u0026thinsp;18 years; n\u0026thinsp;=\u0026thinsp;98\u0026thinsp;\u0026ge;\u0026thinsp;18 years); 95% male; 69% White, 15% Black, 3% Asian and 12% Other race. Thirty-two (32%) smoked tobacco and 8% had a fami1y history of kidney disease (defined as a reported history of CKD, end-stage kidney disease, or known congenital anomalies of the kidney and urinary tract [CAKUT]). Thirty-two (32%) of patients had a crossing vessel which could cause an extrinsic compression of the ureteropelvic junction, and \u0026lt;\u0026thinsp;1% had other CAKUT conditions present. Twenty-two (22%) had history of renal calculi pre-pyeloplasty (without concomitant obstruction); 27% had renal calculi post-pyeloplasty. Approximately 7% had a history of recurrent urinary tract infections, defined as \u0026ge;\u0026thinsp;2 infections within 6 months or \u0026ge;\u0026thinsp;3 infections within 12 months. Six (6%) had history of pyelonephritis but was not present at time of UPJO.\u003c/p\u003e \u003cp\u003eFifty-five (55%) had right-sided, 40% left-sided and 6% bilateral UPJO. At diagnosis, 80% presented with abdominal/flank pain. Overall, median BP at diagnosis was 130/78 mmHg and 7% of the study cohort were taking antihypertensive drugs (vs. 24% at last follow-up). Among those with available data on BP readings (n\u0026thinsp;=\u0026thinsp;81), 60% had defined HTN (based on BP medication use and/or average of 2 BP readings\u0026thinsp;\u0026ge;\u0026thinsp;130/80mmHg) prior to UPJO diagnosis. Mean body mass index at diagnosis was 28 kg/m\u003csup\u003e2\u003c/sup\u003e. Mean serum creatinine at diagnosis was 1.1mg/dl (mean eGFR 93ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e); and 22% had proteinuria\u0026thinsp;\u0026ge;\u0026thinsp;30mg/dL on urinalysis. Compared to patients who did not receive surgical management, those who did were significantly more likely to have crossing vessels (7% vs. 36%, respectively) and abdominal/flank pain (57% vs. 83%, respectively). Otherwise, the 2 groups were comparable at baseline.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, 87% had undergone at least one procedure (pyeloplasty and/or stent), thus 13% did not have any surgical intervention. Eighty-five (85%) had pyeloplasty and 23% underwent stent procedure; only 2 out of 107 (1.8%) patients had stenting procedure without pyeloplasty. Due to refractory pain or non-functional kidney, 16/108 (15%) of patients underwent nephrectomy, with a substantially greater percentage occurred in those who did not have pyeloplasty (9/14 [64%] in the non-intervention group vs. 7/94 [7%] in the intervention group; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFor those who underwent intervention (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003eA), the mean eGFR at diagnosis (pre-intervention) and last follow-up (post-intervention) were 94 and 93ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e, respectively (p\u0026thinsp;=\u0026thinsp;0.15). Ultimately, 54% of the intervention group had eGFR\u0026thinsp;\u0026ge;\u0026thinsp;90ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e; 43% had eGFR\u0026thinsp;\u0026ge;\u0026thinsp;60 and \u0026lt;\u0026thinsp;90; and only 3% had eGFR\u0026thinsp;\u0026ge;\u0026thinsp;30 and \u0026lt;\u0026thinsp;60. Systolic BP decreased significantly with pyeloplasty (131mmHg pre vs. 125mmHg post, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but there was no change in diastolic BP (78mmHg pre vs. 78mmHg post, p\u0026thinsp;=\u0026thinsp;0.20). There was no significant difference in defined HTN pre- and post-intervention (59% pre vs. 61% post, p\u0026thinsp;=\u0026thinsp;0.20). For the non-intervention group, there were no significant differences in the initial and final parameters in eGFR, BP and defined HTN. Moreover, there were no significant differences in eGFR, BP and defined HTN between the intervention vs. non-intervention group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e, intervention of right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p\u0026thinsp;=\u0026thinsp;0.01) and T\u0026frac12; emptying time (35 minutes pre vs. 19 minutes post, p\u0026thinsp;=\u0026thinsp;0.009). Similar trends occurred with left-sided UPJO but were not significant (delayed cortical excretion, 59% pre vs. 44% post, p\u0026thinsp;=\u0026thinsp;0.09; T\u0026frac12; emptying time, 25 minutes pre vs. 24 minutes post, p\u0026thinsp;=\u0026thinsp;0.77). There were no significant differences in DRF or kidney size pre- and post-procedure for either left-sided or right-sided UPJO.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eUsing EHR data from the MHS that spanned from 2005–2020, we identified 108 service members with congenital UPJO with a mean follow-up of 7 years. The mean age at diagnosis was 25 years, with the majority consisted of White males. Most patients (87%) underwent at least one procedure (predominantly pyeloplasty), and 15% of patients subsequently had nephrectomy with a substantially greater percentage occurred in those who did not undergo pyeloplasty. With few exceptions, the surgical intervention group had comparable baseline characteristics as the non-intervention group.\u003c/p\u003e\n\u003cp\u003eA high proportion (60%) of the study cohort met our definition of HTN (based on BP medication use and/or average of 2 BP readings ≥ 130/80mmHg) prior to UPJO diagnosis. Potential explanations include: 1) hydronephrosis due to UPJO may lead to the development of HTN; 2) historically higher BP thresholds for pharmacologic treatment (≥ 140/90mmHg); thus our young adult patients with BP ≥ 130/80mmHg during the 15-year study period may not be aggressively treated, consistently with our finding that only 7% were prescribed BP medications at UJPO diagnosis; 3) almost all of the study patients (98%) were taking nonsteroidal anti-inflammatory drugs (NSAIDs) which can increase BP; 4) 25% of the study cohort did not have available EHR data on BP readings prior to UPJO diagnosis which may bias the results. This high prevalence of defined HTN persisted after surgical intervention. Nonetheless, the systolic BP significantly decreased from 131mmHg to 125mmHg post-intervention, although this reduction in BP could be confounded by pharmacologic treatment, since 22% of the intervention group were prescribed BP medications at last follow-up. The diastolic BP remained unchanged. Currently there are no large randomized clinical trials investigating the long-term impact on BP following surgical intervention. Experimental animal studies and small prospective studies, mainly in children, have associated hydronephrosis with elevated BP which could be reduced by surgical management of the obstruction. In our adult study, there was no significant difference in the prevalence of defined HTN pre- and post-intervention. In contrast, a retrospective analysis of 49 adults with congenital UPJO (not on antihypertensive medications) showed improvement in both systolic and diastolic BP after surgical intervention; however, these findings were based predominantly on data ≤ 12 months after relief of obstruction\u003csup\u003e13\u003c/sup\u003e. For our non-intervention group, there were no significant differences between the initial and follow-up measures of defined HTN and median BP.\u003c/p\u003e\n\u003cp\u003eOverall, the mean serum creatinine in our cohort was 1.1 mg/dL at diagnosis (mean eGFR 93ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e). There was no significant difference between the eGFR pre-intervention (at diagnosis) vs. post-intervention (7 years after diagnosis). However, based on our findings, it would not be valid to conclude that surgical intervention does not favorably alter the longstanding kidney function trajectory. Our cohort consisted of young adults with minimal comorbidities and preserved kidney function at baseline. And studies with even longer follow-up periods (\u0026gt; 10 years) would be required to detect any differences in eGFR outcome between the intervention and non-intervention group. Almost all (97%) of the patients in the intervention group maintained a robust kidney function (eGFR ≥ 60 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e) at last follow up. There is a paucity of literature examining long-term risk of CKD in adults with congenital UPJO. In an adult cohort with UPJO and advanced CKD, Elbaset et al\u003csup\u003e12\u003c/sup\u003e reported an improvement in eGFR from 15 ± 6 ml/min to 23 ± 10 ml/min after pyeloplasty. However, their cohort characteristics differed substantially from our active-duty cohort (e.g. poor baseline kidney function; \u0026gt;50% of their cohort had positive urine culture). In another study of adult patients with UPJO, there was no significant changes in eGFR after pyeloplasty (68ml/min vs. 80ml/min; p = 0.93) among those with pre-operative DRF ≤ 15%; however, eGFR significantly increased from 93 to 101ml/min (p = 0.005) among those with DRF \u0026gt; 15%\u003csup\u003e14\u003c/sup\u003e. For our non-pyeloplasty group, there was no significant change in eGFR at last follow-up. Caution is warranted in interpreting this finding, considering the high proportion of patients in this group who required nephrectomy. The maintenance of eGFR over the study period likely reflects glomerular hyperfiltration and compensatory hypertrophy which mask the underlying reduced nephron mass, by potentially returning the total eGFR to approximately 85% of baseline after unilateral nephrectomy. Kasiske BL et alreported an increase in measured GFR by 1.47 ml/min/year between 6 and 36 months after living kidney donation compared to an age-related decline by 0.36 ml/min/year in paired healthy nondonors.\u003c/p\u003e\n\u003cp\u003eIn our study, there were no significant differences in DRF and kidney size pre- and post-intervention for either left-sided or right-sided UPJO. However, surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion and decreased T½ emptying time. Similar trends occurred with left-sided UPJO but were not statistically significant likely due to the smaller sample size. Our findings are consistent with a retrospective study by Sivaraman et alwho reported that 97.6% of their adult cohort with UPJO had improved T½ emptying time post-pyeloplasty. Two other small retrospective studies evaluated pre- and post-operative DRF and eGFR but did not report differences in right-sided vs left-sided UPJO\u003csup\u003e,\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOur study has certain limitations. Due to the active-duty population in the MHS, most of the study patients were male which may impact the generalizability of our findings. As a comparison, a recent population-based study based on the Optum Clinformatics database showed that 70% of the UPJO cases were male. Also, since all active-duty service members are required to have a medical screening prior to enlistment, a selection bias may occur such that healthier patients with more mild renal manifestations were included in the study cohort. The proportion of patients who underwent radionuclide scan both before and after surgical intervention was relatively small, which may explain the lack of significance in excretory function for left sided UPJO. Some of the study subjects may receive their care at civilian facilities, outside of the MHS, thus we may not have captured all cases of congenital UPJO. Lastly, we cannot draw conclusions about causality given the retrospective nature of our study.\u003c/p\u003e\n\u003cp\u003eHowever, our study also has unique strengths. The universal EHR in the MHS allowed us to obtain comprehensive and granular clinical data in an integrated and global healthcare system. Our patient cohort included all degrees of clinically significant obstruction, number and surgical techniques of pyeloplasty, and long-term outcomes regarding BP, renal excretory function, and kidney function estimated by the 2021 CKD-EPI creatinine equation. Moreover, our large study cohort is racially diverse with a substantially longer follow-up period than prior studies. Therefore, our study findings narrow the important knowledge gap on renal outcomes in the young adult population with congenital UPJO.\u003c/p\u003e\n\u003cp\u003eIn this large cohort of young (predominantly male) adults with congenital UPJO, we found that surgical intervention was not associated with significant differences in the subsequent prevalence of HTN and level of kidney function over the long term; however, renal excretory function improved on radionuclide scans. Further studies are greatly needed to assess the long-term BP and renal outcomes of surgical intervention in adults with congenital UPJO to determine the appropriate follow-up medical management for this patient population.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003eThe authors have no relevant financial or non-financial interests, or conflicts of interests. No funding was received for conducting this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDisclaimer\u003c/u\u003e: The views expressed in this manuscript are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government. Stephen W. Olson, MD is currently an employee of Novartis Pharmaceuticals.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eWe would like to acknowledge Sarah Khan, MD, Erin Parker, MD, and John Thurlow, MD for their contributions to this study. We also appreciate the advice from our urology colleagues, Thomas Gerald, MD and Brock Boehm, MD. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor Contributions\u003c/u\u003e: Conceptualization: ARS, SWO, RN; Methodology: ARS, SWO, BLL, MAW, CMY, RN; Formal analysis and investigation: ARS, SWO, RN; Writing-original draft preparation: ARS, RN; Writing-review and editing: ARS, SWO, BLL, MAW, CMY, RN; Supervision: RN\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKhan F, Ahmed K, Lee N, Challacombe B, Khan MS, Dasgupta P. Management of ureteropelvic junction obstruction in adults. 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Contemporary National Surgical Outcomes in the Treatment of Ureteropelvic Junction Obstruction. Urology. 2015;85(2):363-367. doi:10.1016/j.urology.2014.07.068\u003c/li\u003e\n\u003cli\u003eSzydełko T, Kasprzak J, Apoznański W, et al. Clavien Classification of Complications After 150 Laparoscopic Pyeloplasties. Urology. 2011;77(6):1359-1364. doi:10.1016/j.urology.2010.12.025\u003c/li\u003e\n\u003cli\u003eLam W, Fernando A, Issa R, et al. Is Routine Postoperative Diuresis Renography Indicated in All Adult Patients After Pyeloplasty for Ureteropelvic Junction Obstruction? Urology. 2015;85(1):246-251. doi:10.1016/j.urology.2014.09.033\u003c/li\u003e\n\u003cli\u003eElbaset MA, Zahran MH, Sharaf MA, et al. Long Term Functional Success After Pyeloplasty for Pelvi-Ureteral Junction Obstruction in Unilateral Poorly Functioning Kidney in Exclusively Adults Population. Urology. 2019;131:234-239. doi:10.1016/j.urology.2019.05.030\u003c/li\u003e\n\u003cli\u003eAl-Mashhadi A, H\u0026auml;ggman M, L\u0026auml;ckgren G, et al. Changes of arterial pressure following relief of obstruction in adults with hydronephrosis. Upsala Journal of Medical Sciences. 2018;123(4):216-224. doi:10.1080/03009734.2018.1521890\u003c/li\u003e\n\u003cli\u003eNascimento B, Andrade HS, Miranda EP, Barbosa JABA, Moscardi PR, Arap MA, Mitre AI, Srougi M, Srougi V, Duarte RJ. Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction. Int Urol Nephrol. 2021 Feb;53(2):269-273. doi: 10.1007/s11255-020-02626-4. Epub 2020 Aug 29. PMID: 32862329.\u003c/li\u003e\n\u003cli\u003eElbaset MA, Elmeniar AM, Sharaf MA, Ezzat O, Elgamal M, Edwan M, Badawy M, Osman Y. Critical analysis of pyeloplasty role in adults with late diagnosis of ureteropelvic junction obstruction-a comparative study. 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PMID: 37802192; PMCID: PMC10843281.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline demographic and clinical characteristics of the cohort at diagnosis of congenital ureteropelvic junction obstruction\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention Group (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-Intervention Group (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103/108 (95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89/94 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14/14 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRace group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68/99 (68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62/87 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/12 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15/99 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/87 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/12 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/99 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/87 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/12 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNative American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/99 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/87 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/12 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12/99 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/87 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/12 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of hypertension\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49/81 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/70 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/11 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAntihypertensive drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/108 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/94 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26/108 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/94 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/14 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNSAID use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100/102 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88/89 (99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12/13 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatin use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/108 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/94 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/14 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTobacco use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35/108 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29/94 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/14 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIllicit drug use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/108 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/94 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/14 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily history of kidney disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/107 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/93 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCrossing vessel present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35/108 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34/94 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther CAKUT present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/108 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/94 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/14 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal calculi present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24/108 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/94 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/14 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of recurrent urinary tract infections\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/108 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/94 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of pyelonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/108 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/94 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdominal/flank pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86/108 (79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78/94 (83.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/14 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaterality of obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight-sided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59/108 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52/94 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/14 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft-sided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43/108 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37/94 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/14 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/108 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/94 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBody mass index, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic Blood pressure, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore diagnosis (n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 (121\u0026ndash;131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126 (121\u0026ndash;131)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127 (118\u0026ndash;134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (122\u0026ndash;138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (122\u0026ndash;138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129 (120\u0026ndash;134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic Blood pressure, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore diagnosis (n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76 (69\u0026ndash;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (68\u0026ndash;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (69\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (70\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (70\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (73\u0026ndash;87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHgbA1C, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (%), (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSerum creatinine at diagnosis, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (mg/dL) (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eeGFR at diagnosis, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e) (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtein on urinalysis at diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75/96 (78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65/84 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/12 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/96 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/84 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/12 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;50 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/96 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/84 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/12 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData are expressed as n/N (%), unless otherwise indicated\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic\u0026thinsp;\u0026ge;\u0026thinsp;130mmHg or average diastolic\u0026thinsp;\u0026ge;\u0026thinsp;80mmHg\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Recurrent urinary tract infections are defined as \u0026ge;\u0026thinsp;2 infections within 6 months or \u0026ge;\u0026thinsp;3 infections within 12 months\u003c/p\u003e\n\u003cp\u003eACE inhibitor: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blockers; NSAID: nonsteroidal anti-inflammatory drugs; CAKUT: congenital anomalies of the kidney and urinary tract; HgbA1C: glycated hemoglobin A1C; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation; IQR: interquartile range; SD: standard deviation\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSurgical intervention for congenital ureteropelvic junction obstruction\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePyeloplasty (open, robotic or laparoscopic)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92/108 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16/108 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80/108 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12/108 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStent placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25/107 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82/107 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22/107 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3/107 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal procedures (pyeloplasty and/or stent placement)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94/108 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14/108 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64/108 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20/108 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10/108 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16/108 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData are expressed as n/N (%)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eA: Renal function and blood pressure outcomes in congenital ureteropelvic junction obstruction, within-group comparisons\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-Intervention Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e, \u003cstrong\u003en/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-UPJO diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/70 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/11 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57/94 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/14 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood Pressure, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (122\u0026ndash;138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129 (120\u0026ndash;134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 (120\u0026ndash;130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124 (121\u0026ndash;128)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (70\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (73\u0026ndash;87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (73\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (80\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (ml/min/1.73m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e McNemar test for paired proportions and paired \u003cem\u003et\u003c/em\u003e-tests for paired continuous observations\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003cstrong\u003e2\u003c/strong\u003e\u0026nbsp;\u003c/sup\u003e Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic\u0026thinsp;\u0026ge;\u0026thinsp;130mmHg or average diastolic\u0026thinsp;\u0026ge;\u0026thinsp;80mmHg\u003c/p\u003e\n\u003cp\u003eUPJO: ureteropelvic junction obstruction; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eB: Renal function and blood pressure outcomes in congenital ureteropelvic junction obstruction, between-group comparisons\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-Intervention Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003e, \u003cstrong\u003en/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePre-UPJO diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/70 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/11 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57/94 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/14 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood Pressure, median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131 (122\u0026ndash;138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129 (120\u0026ndash;134)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 (120\u0026ndash;130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124 (121\u0026ndash;128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (70\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (73\u0026ndash;87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (73\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (80\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (ml/min/1.73m\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt diagnosis (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt last follow-up (n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Hypertension is defined as any prescription for BP medication and/or average of two BP readings more than 2 weeks apart, with average systolic\u0026thinsp;\u0026ge;\u0026thinsp;130mmHg or average diastolic\u0026thinsp;\u0026ge;\u0026thinsp;80mmHg\u003c/p\u003e\n\u003cp\u003eUPJO: ureteropelvic junction obstruction; eGFR: estimated glomerular filtration rate, based on the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKidney size and renal excretory function in congenital ureteropelvic junction obstruction before and after surgical intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre- Intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost- Intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft-sided UPJ obstruction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKidney size (ultrasound), cm (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifferential function (%) (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelayed cortical excretion, n/N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17/29 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12/27 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u0026frac12; emptying time (Lasix scan), min (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight-sided UPJ obstruction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKidney size (ultrasound), cm (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifferential function (%) (n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelayed cortical excretion, n/N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20/37 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14/40 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u0026frac12; emptying time (Lasix scan), min (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e McNemar test for paired proportions and paired \u003cem\u003et\u003c/em\u003e-tests for paired continuous observations\u003c/p\u003e\n\u003cp\u003eUPJ: ureteropelvic junction\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Congenital ureteropelvic junction obstruction, congenital anomalies of the kidney and urinary tract (CAKUT), hypertension, kidney function, pyeloplasty, Military Health System","lastPublishedDoi":"10.21203/rs.3.rs-4229645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4229645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo evaluate the impact of surgical intervention on long-term renal outcomes for adult patients with congenital ureteropelvic junction obstruction (UPJO).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe 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\u0026thinsp;\u0026ge;\u0026thinsp;130/80mmHg more than 2 weeks apart), and changes in renal excretory function on radionuclide scans.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe 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 130/78mmHg and mean eGFR 93ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e. 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/1.73m\u003csup\u003e2\u003c/sup\u003e, respectively; p\u0026thinsp;=\u0026thinsp;0.15) and prevalence of defined HTN (59% vs. 61%, respectively; p\u0026thinsp;=\u0026thinsp;0.20). Surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p\u0026thinsp;=\u0026thinsp;0.01) and T\u0026frac12; emptying time (35 min vs. 19 min, p\u0026thinsp;=\u0026thinsp;0.009). Similar trends occurred with left-sided UPJO but were not significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSurgical 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.\u003c/p\u003e","manuscriptTitle":"Surgical Intervention and Long-Term Renal Outcomes of Congenital Ureteropelvic Junction Obstruction in a Young Adult Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-12 09:21:58","doi":"10.21203/rs.3.rs-4229645/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e580b8ee-e9a9-4d69-aaf2-38e919b72da7","owner":[],"postedDate":"April 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-14T21:19:49+00:00","versionOfRecord":{"articleIdentity":"rs-4229645","link":"https://doi.org/10.1007/s11255-024-04075-9","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2024-05-11 21:17:29","publishedOnDateReadable":"May 11th, 2024"},"versionCreatedAt":"2024-04-12 09:21:58","video":"","vorDoi":"10.1007/s11255-024-04075-9","vorDoiUrl":"https://doi.org/10.1007/s11255-024-04075-9","workflowStages":[]},"version":"v1","identity":"rs-4229645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4229645","identity":"rs-4229645","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}