Renal parenchymal thickness and urinary protein levels in patients with ureteropelvic junction obstruction after nephrostomy placement.
OBJECTIVE
To assess recovery of renal parenchymal thickness and urinary protein levels in patients with severely hydronephrotic kidneys after nephrostomy placement.


METHODS
Fourteen patients (median age 1 year, range 6 months-7 years) who underwent nephrostomy placement for unilateral ureteropelvic junction obstruction at our hospital between May 2007 and January 2009 were included in a retrospective analysis. All patients had severe hydronephrosis, with a median parenchymal thickness of 1.8 mm (range 1-2.5 mm). Kidney morphology was examined by ultrasound before the procedure and 1, 2, 3, 4, 6 and 8 weeks after. Urinary proteins (including albumin, immunoglobulin [IgG], alpha2-macroglobulin, alpha1-microglobulin, beta2-microglobulin [beta2-MG] and kappa chain) and creatinine levels were also tested during these follow-up visits. Fifteen healthy children were assessed for urinary protein levels as well and made up the control group.


RESULTS
Parenchymal thickness increased within 4 weeks of nephrostomy placement. Kidney volumes were significantly decreased within 2 weeks. No further changes in morphology were detected after 4 weeks. Urinary alpha1-microglobulin and beta2-MG levels decreased to baseline within 1 and 4 weeks, respectively. Urinary albumin, IgG, alpha2-macroglobulin and kappa chain levels decreased gradually after nephrostomy, but did not return to baseline within 8 weeks.


CONCLUSIONS
After nephrostomy placement, parenchymal thickness increases within 4 weeks, tubular function returns to normal earlier than glomerular function and glomerular membrane repair is inversely correlated with the severity of damage.
Deng
Gao-Yan
GY
Department of Pediatric Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guang Zhou, China. denggaoyanemail@163.com
Sun
Jun-Jie
JJ
Wang
Pa
P
Mo
Jia-Cong
JC
D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D005260:Female; D005916:Globulins / Q000652:urine; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D007074:Immunoglobulin G / Q000652:urine; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D009403:Nephrostomy, Percutaneous; D057234:Preoperative Period; D011507:Proteinuria / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D013520:Urologic Surgical Procedures
D005916:Globulins; D007074:Immunoglobulin G; D003404:Creatinine