SURGICAL OUTCOMES IN EARLY CHILDHOOD POSTRENAL CALCULOUS ANURIA

Abstract

Pediatric patients with postrenal acute kidney injury (AKI) due to ureteral obstruction often require timely intervention to prevent renal damage and complications. This study aimed to assess the clinical outcomes of different therapeutic approaches for pediatric patients with postrenal AKI.

Methods: A total of 53 pediatric patients, aged 4 months to 3 years, were included in this study. They were categorized into two groups based on the presence and duration of anuria, as well as the underlying conditions. Diagnostic evaluations included ultrasonography, radiography of the urinary tract, and radioisotope renography. Additionally, renal hemodynamics were assessed using Doppler ultrasound.

Results: Among the patients, 35 (66%) exhibited unilateral calculous obstruction, leading to reflex anuria within 3 days, with associated symptoms of systemic distress. The remaining 18 (33.9%) patients had anuria due to bilateral obstruction or single functioning kidneys for over 3 days, often accompanied by systemic complications. Doppler ultrasound revealed significant differences in intrarenal vascular patterns and resistive indices between the groups. Patients in the first group showed improvements in renal hemodynamics following surgical intervention, while those in the second group experienced delayed recovery.

Conclusion: The findings emphasize the importance of prompt and tailored treatment in pediatric patients with postrenal AKI. Patients with acute unilateral obstruction can benefit from early surgical intervention, while those with bilateral or prolonged obstruction may benefit from preoperative high urinary diversion, leading to better postoperative renal function. Understanding the timing and appropriate management of postrenal AKI in pediatric patients is crucial for optimizing clinical outcomes and minimizing complications.