Factors influencing the non-recovery of renal function after the relief of urinary tract obstruction in women with cancer of cervix.
OBJECTIVE
To identify factors associated with non-recovery of renal function after the relief of urinary tract obstruction in women with cancer of cervix.


METHODS
Thirty-seven women with cancer of cervix and obstructive renal failure were prospectively studied. Patients were evaluated in the day before nephrostomy (D0); and in the 1st (D1), 7th (D7), and 30th day (D30) after unilateral nephrostomy. The following parameters were analyzed: age serum urea, and serum creatinine (S(creat)), in D0, D7, and D30. Renal cortical thickness was measured by ultrasonography in D0. During nephrostomy procedure, urine samples for urinalysis and culture were collected and renal biopsy was attempted. Patients were divided in two groups according to S(creat) in D30: patients with S(creat) < 1, 4mg/dL (R group) and those with S(creat) > or = 1, 4mg/dL (nR group).


RESULTS
Ten patients died before D30 and were not studied. R group (n = 12) was younger (43 +/- 9 vs. 52 +/- 10 years, p < 0.05) than nR group (n = 15), and presented lower serum urea in D0 (134 +/- 67 vs. 212 +/- 51 mg/dL, p < 0.01) and in D7 (94 +/- 20 vs. 155 +/- 18 mg/dL, p < 0.05). Renal cortex was thicker in R group (17 +/- 1 vs. 13 +/- 1 mm, p < 0.05). Survival was higher in R group (11/12) than in nR group (0/15, p < 0.01). All urine samples showed leukocyturia but culture was positive in only two. In three out of nine biopsy attempts enough material was obtained. Light microscopy revealed interstitial fibrosis plus tubular atrophy, and partial glomerular fibrosis was present in two biopsies.


CONCLUSIONS
The non-recovery of renal function after the relief of obstruction in human obstructive renal failure is associated with older age and decreased renal cortical thickness. The complete renal recovery improves patient survival despite malignancy.
Hospital das Clínicas, Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Lutaif
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Yu
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Abdulkader
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012078:Renal Artery Obstruction / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D014570:Urologic Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*