الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The prediction of the recoverability of kidney function after treatment of unilateral obstructive uropathy is of great clinical value to the urologists and nephrologists as it may affect the decision of treatment either to release the obstruction (if recoverability is probable) or no need for that (if irreversible damage occured).
There is an agreement that in obstructed kidney, if the radioisotope estimated split function of less than 10%, this warrants symptomatic non-surgical treatment or even nephrectomy if indicated. In practice, this critical decision is verified by some urologists through isotope scanning 6 weeks after drainage of the obstructed kidney for possible recoverability and assessment of the renal split function.
This study was performed to assess the impact of doing that, by detecting changes in split renal function of unilaterally obstructed kidney with normal contralateral kidney after a period of 6 weeks of drainage.
This study included 66 adult patients with unilateral obstructive uropathy and radiological grade 3 or 4 hydronephrosis while the contralateral kidney was normal. It was done in the period from April 2018 to April 2020.
All Patients were diagnosed and evaluated by detailed medical history, physical examination, laboratory investigations (including urine analysis, urine culture if needed, serum creatinine), and imaging evaluation (including abdomino-pelvic ultrasound, KUB and Spiral C.T scans). The causes of unilateral obstructive uropathy in the patients included in this study was: ureteric stone (33 patients with various stone levels), renal pelvic stone (16 patients with variable
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stone sizes), UPJ obstruction (12 patients) and stricture ureter (5 patients).
All the patients included in the study underwent isotope renography with estimation of split function on presentation prior to drainage. Then all cases underwent drainage of their obstructed kidneys either through PCN or ureteric stents. And isotope renography was repeated 6 weeks after drainage to assess the recoverability of renal function by comparing split function in isotope renal scan prior drainage and 6 weeks after drainage.
The included 66 patients in this study was divided into 2 groups; group A which include 36 patients with split function less than 10 % and group B which include 30 patients with split function, 10 % or more.
The mean age of patients in our study were 43.83 ± 10.49 (range 23 to 67 years). It included 50 men and 16 women. The most common presentation was loin pain in 97% of patients, while 2 patients were pain free. The obstructed kidney was the right one in 39.4% of patients and the left kidney in 60.6% of patients. A total of 66 patients of the study, 33 patients (20 in group A and 13 in group B) were drained through PCN and 33 patients (16 in group A and 17 in group B) were drained through ureteric stent.
The median values of pre and postoperative renographic split function were, 7 (6 - 8.5) and 7 (6 - 8.5) in group A. While median values were 16.5 (14 - 20) and 21.5 (14 - 32) in group B
The results of the study showed that there were an insignificant difference between the two groups in age, sex, cause of obstruction, laterality of obstruction, method of drainage and patient`s presentation.
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There was an insignificant difference pre and post drainage for group A. While there highly significance difference pre and post drainage for group B. So, the preoperative selective renographic split function of the obstructed kidney is the independent factor affecting renal functional recovery.