The Split Renal Function at Presentation, Associated Factors and Management in Adult Patients With Pelvi-ureteric Junction Obstruction(Pujo) at Kenyatta National Hospital

Abstract

Background: Pelvi-ureteric Junction obstruction is a condition that causes a risk of renal loss. A significant number of adults present with impaired split renal function; however, this number is not well described in contemporary literature. Early diagnosis and treatment is paramount to preserve renal function. Pyeloplasty is the gold standard in the management of pelvi-ureteric junction obstruction and nephrectomy is performed in kidneys which become non-functioning and symptomatic. Objectives: To determine the split renal function at presentation, associated factors, and management in adult patients with pelvi-ureteric junction at Kenyatta National Hospital. Study design: Retrospective cross-sectional study Study sites: Kenyatta National Hospital Methodology: Using a consecutive sampling approach, patients diagnosed with pelvi-ureteric junction obstruction between January 2017 and December 2022 were recruited using file records. The demographics and clinical characteristics of the participants were recorded. The outcomes of interest were the split renal function and its management. Results:

The mean age of the study participants was 30 years, SD ± 10.7, median 27, range 14 – 63. The majority were males, 49 (59%) compared to females, 34 (41%). Flank pain was the most common type of symptom occurring in all patients. Most patients experienced symptoms on the left side (59%). The mean of duration of symptoms at presentation was 35.3 months, SD 45.9, median 19, with a range of 0.5 – 240 months. The most common aetiology of PUJO was intrinsic stenosis in 70% of the patients. The mean SRF for right PUJO was 23.5%, SD 11.6, median 26%, range 1% – 39%. The mean SRF for left PUJO was 19.8%, SD 13.1, median 17.5% and range 2% – 50%. The overall SRF was 21.3%, SD 12.5, median 23%, range 1% – 50%. Pyeloplasty was the most common management technique in 68.7% of the participants. Nephrectomy was done in 31.3% of the patients. Adjunctive procedures such as DJ stenting were also performed in 15.7% patients and percutaneous nephrostomy in 1.2% of the patients. Conclusion: The findings from this study are consistent with those of previous studies. It provides valuable insights into the clinical characteristics, diagnosis, and management of patients with PUJO in Kenyatta National Hospital. The factors that are associated with SRF are described with aetiology showing a positive association with worse SRF. All the patients were managed surgically with pyeloplasty being the most common. Further research is warranted to elucidate the underlying pathophysiological mechanisms and optimize diagnosis and treatment strategies for better renal function of this challenging condition