title: Irreversible Renal Function Impairment Due to Silent Ureteral Stones.
abstract: To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed.
  
  
  
  We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and (99m)Tc-dimercaptosuccinic acid. Patients without complete pre- and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression.
  
  
  
  Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P = .89), GFR (P = .48), and renal function at scintigraphy (P = .19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P = .065).
  
  
  
  Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment.
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: marchinism@gmail.com.
authors.forename: Giovanni S
authors.initials: GS
authors.lastname: Marchini
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Fábio Carvalho
authors.initials: FC
authors.lastname: Vicentini
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Fábio César
authors.initials: FC
authors.lastname: Torricelli
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Danilovic
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Artur Henrique
authors.initials: AH
authors.lastname: Brito
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Cesar
authors.initials: C
authors.lastname: Câmara
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology* / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D014514:Ureteral Calculi / Q000150:complications* / Q000503:physiopathology*