Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study
Objective Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) duri...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e030438.full |
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| author | Su-Hyun Kim Eung Hyun Lee Jung-ho Shin Sung Bin Park Byung Hoon Chi Jin Ho Hwang |
| author_facet | Su-Hyun Kim Eung Hyun Lee Jung-ho Shin Sung Bin Park Byung Hoon Chi Jin Ho Hwang |
| author_sort | Su-Hyun Kim |
| collection | DOAJ |
| description | Objective Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.Design Retrospective cohort study.Setting and participants 1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.Outcome measures Estimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.Results When the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.Conclusions In patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function. |
| format | Article |
| id | doaj-art-6fa0fc2ed5e441f881796ec1ee2f9f0e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6fa0fc2ed5e441f881796ec1ee2f9f0e2024-11-29T01:45:08ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-030438Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort studySu-Hyun Kim0Eung Hyun Lee1Jung-ho Shin2Sung Bin Park3Byung Hoon Chi4Jin Ho Hwang51 Internal Medicine, Chung-Ang University Hospital, Seoul, Korea1 Internal Medicine, Chung-Ang University Hospital, Seoul, KoreaDepartment of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan2 Radiology, Chung-Ang University Hospital, Seoul, Korea3 Urology, Chung-Ang University Hospital, Seoul, KoreaDepartment of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)Objective Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.Design Retrospective cohort study.Setting and participants 1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.Outcome measures Estimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.Results When the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.Conclusions In patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.https://bmjopen.bmj.com/content/9/11/e030438.full |
| spellingShingle | Su-Hyun Kim Eung Hyun Lee Jung-ho Shin Sung Bin Park Byung Hoon Chi Jin Ho Hwang Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study BMJ Open |
| title | Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study |
| title_full | Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study |
| title_fullStr | Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study |
| title_full_unstemmed | Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study |
| title_short | Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study |
| title_sort | effects on renal outcome of concomitant acute pyelonephritis acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/9/11/e030438.full |
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