Role of Nephrostomy in poorly functioning kidneys in patients of ureteropelvic junction obstruction

To assess the role of Percutaneous nephrostomy in poorly functioning kidneys of ureteropelvic junction obstruction in pediatric patients. Several studies have addressed the unique management challenges in poorly functioning kidneys with ureteropelvic junction obstruction. Trial with percutaneous drainage of such kidneys as a guide to management would be a solution to this dilemma.  A prospective study was performed on poorly functioning kidneys (split renal function<10% on renal dynamic scan) of patients with unilateral ureteropelvic junction obstruction from August, 2016 to January, 2018. Ultrasound-guided nephrostomy was inserted in these patients. Data regarding the differential renal function and glomerular function rate was collected before and after nephrostomy insertion. Decision regarding pyeloplasty or nephrectomy of the involved kidney was taken if differential function and Glomerular filtration rate increased following drainage. Data collected was analyzed statistically.   33 patients of unilateral ureteropelvic junction obstruction with poorly functioning kidneys were treated during this period. 30 patients had significant increase in differential function and glomerular filtration rate. These patients underwent pyeloplasty. In 2 patients, these parameters did not increase much and they benefitted from nephrectomy. One patient had an infected kidney which did not improve significantly on drainage and had to be removed. Of the 30 patients who had pyeloplasty, two developed obstruction after 3 months of removal of double-J stent and had to be re-operated. Percutaneous nephrostomy in poorly functioning kidneys with ureteropelvic junction obstruction helps to identify potentially salvageable kidneys which merit pyeloplasty. Kidneys which do not improve with nephrostomy are unlikely to improve with pyeloplasty and therefore nephrectomy is done in such cases.