Isolated low initial differential renal function in patients
with primary non-refluxing megaureter should not be considered
an indication for early surgery: A multicentric study

J 2016

Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study

DRLÍK, Marcel, Hana FLOGELOVÁ, Martin KUBÁT, Jan TOMÁŠEK, Pavel ZERHAU et. al.

Basic information

Original name

Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study

Authors

DRLÍK, Marcel (203 Czech Republic), Hana FLOGELOVÁ (203 Czech Republic), Martin KUBÁT (203 Czech Republic, belonging to the institution), Jan TOMÁŠEK (203 Czech Republic), Pavel ZERHAU (203 Czech Republic, guarantor, belonging to the institution), Oldřich ŠMAKAL (203 Czech Republic), Ivo NOVÁK (203 Czech Republic), Martin KOMARC (203 Czech Republic) and Radim KOČVARA (203 Czech Republic)

Edition

Journal of Pediatric Urology, Oxford, Elsevier Science BV, 2016, 1477-5131

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30209 Paediatrics

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 1.611

RIV identification code

RIV/00216224:14110/16:00092513

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jpurol.2016.05.025

UT WoS

000384668400037

Keywords in English

Primary non-refluxing megaureter; Low differential renal function; Conservative treatment

Abstract

V originále

Introduction Low initial differential renal function (DRF) in patients with primary non-refluxing megaureter (PNRM) is considered an indication for surgery as are an increase of dilatation and symptoms. Objective We hypothesized that low DRF is not necessarily a result of obstruction, but may be due to impaired development of the upper urinary tract. Thus, in the absence of symptoms, there is a low risk for further loss of renal function. This study aimed to assess whether initially low DRF is a reliable indicator of obstruction. Study design We reviewed data from four university centers between 1995 and 2010. Patients under 12 months of age with unilateral primary non-refluxing megaureter (PNMR) and a DRF between 10% and 40%, and followed minimally 24 months, were included. Patients were placed in two groups based on management: group A, surgical; group B, conservative. The dynamics of DRF in relation to age and type of treatment was studied. In each patient we recorded the earliest (initial) DRF, the last known (final) DRF, the age when MAG-3 scans were performed and the type of treatment. Results From 25 patients, 16 were treated surgically (group A) and 9 followed conservatively (group B). The initial mean DRF in group A was 33.1% and in group B 34.5%, at a mean age 3.0 and 3.6 months, respectively. The final mean DRF in group A was 40.1% and in group B 43%, at a mean age 59.9 and 46.3 months, respectively. Using two-way repeated ANOVA (age [initial DRF, final DRF] vs. group [group A, group B]), we found non-significant difference between the groups in the DRF, F (1, 21) = 0.96, p = 0.338, while we observed statistically significant and similar increase from the initial to final DRF in both groups, F (1, 21) = 16.66, p = 0.001 (Figure). Discussion This is the first study focusing on the evolution of renal function in patients with PNRM and low initial DRF. Results suggest that the diagnosis of obstruction is inaccurate in most infants with unilateral PNRM if it is based on low initial DRF only. Renal deterioration rarely occurs in asymptomatic patients, and even profoundly impaired kidneys have potential for improvement. Limitations of our study include retrospective design and lack of standardization of treatment among the four centers. Conclusion Low DRF in asymptomatic and anatomically stable patients with PNMR should not be considered an indication for early surgery. These findings challenge current practice and should be confirmed by a prospective study.

Citovat

DRLÍK, Marcel, Hana FLOGELOVÁ, Martin KUBÁT, Jan TOMÁŠEK, Pavel ZERHAU, Oldřich ŠMAKAL, Ivo NOVÁK, Martin KOMARC and Radim KOČVARA. Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study. Journal of Pediatric Urology. Oxford: Elsevier Science BV, 2016, vol. 12, No 4, p. "231.e1"-"231.e4", 4 pp. ISSN 1477-5131. Available from: https://dx.doi.org/10.1016/j.jpurol.2016.05.025.

@article{1365781,
   author = {Drlík, Marcel and Flogelová, Hana and Kubát, Martin and Tomášek, Jan and Zerhau, Pavel and Šmakal, Oldřich and Novák, Ivo and Komarc, Martin and Kočvara, Radim},
   article_location = {Oxford},
   article_number = {4},
   doi = {http://dx.doi.org/10.1016/j.jpurol.2016.05.025},
   keywords = {Primary non-refluxing megaureter; Low differential renal function; Conservative treatment},
   language = {eng},
   issn = {1477-5131},
   journal = {Journal of Pediatric Urology},
   title = {Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study},
   volume = {12},
   year = {2016}
}

TY  - JOUR
ID  - 1365781
AU  - Drlík, Marcel - Flogelová, Hana - Kubát, Martin - Tomášek, Jan - Zerhau, Pavel - Šmakal, Oldřich - Novák, Ivo - Komarc, Martin - Kočvara, Radim
PY  - 2016
TI  - Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study
JF  - Journal of Pediatric Urology
VL  - 12
IS  - 4
SP  - "231.e1"-"231.e4"
EP  - "231.e1"-"231.e4"
PB  - Elsevier Science BV
SN  - 14775131
KW  - Primary non-refluxing megaureter
KW  - Low differential renal function
KW  - Conservative treatment
N2  - Introduction Low initial differential renal function (DRF) in patients with primary non-refluxing megaureter (PNRM) is considered an indication for surgery as are an increase of dilatation and symptoms. Objective We hypothesized that low DRF is not necessarily a result of obstruction, but may be due to impaired development of the upper urinary tract. Thus, in the absence of symptoms, there is a low risk for further loss of renal function. This study aimed to assess whether initially low DRF is a reliable indicator of obstruction. Study design We reviewed data from four university centers between 1995 and 2010. Patients under 12 months of age with unilateral primary non-refluxing megaureter (PNMR) and a DRF between 10% and 40%, and followed minimally 24 months, were included. Patients were placed in two groups based on management: group A, surgical; group B, conservative. The dynamics of DRF in relation to age and type of treatment was studied. In each patient we recorded the earliest (initial) DRF, the last known (final) DRF, the age when MAG-3 scans were performed and the type of treatment. Results From 25 patients, 16 were treated surgically (group A) and 9 followed conservatively (group B). The initial mean DRF in group A was 33.1% and in group B 34.5%, at a mean age 3.0 and 3.6 months, respectively. The final mean DRF in group A was 40.1% and in group B 43%, at a mean age 59.9 and 46.3 months, respectively. Using two-way repeated ANOVA (age [initial DRF, final DRF] vs. group [group A, group B]), we found non-significant difference between the groups in the DRF, F (1, 21) = 0.96, p = 0.338, while we observed statistically significant and similar increase from the initial to final DRF in both groups, F (1, 21) = 16.66, p = 0.001 (Figure). Discussion This is the first study focusing on the evolution of renal function in patients with PNRM and low initial DRF. Results suggest that the diagnosis of obstruction is inaccurate in most infants with unilateral PNRM if it is based on low initial DRF only. Renal deterioration rarely occurs in asymptomatic patients, and even profoundly impaired kidneys have potential for improvement. Limitations of our study include retrospective design and lack of standardization of treatment among the four centers. Conclusion Low DRF in asymptomatic and anatomically stable patients with PNMR should not be considered an indication for early surgery. These findings challenge current practice and should be confirmed by a prospective study.
ER  -

DRLÍK, Marcel, Hana FLOGELOVÁ, Martin KUBÁT, Jan TOMÁŠEK, Pavel ZERHAU, Oldřich ŠMAKAL, Ivo NOVÁK, Martin KOMARC and Radim KOČVARA. Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study. \textit{Journal of Pediatric Urology}. Oxford: Elsevier Science BV, 2016, vol.~12, No~4, p.~''231.e1''-''231.e4'', 4 pp. ISSN~1477-5131. Available from: https://dx.doi.org/10.1016/j.jpurol.2016.05.025.

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