65 ISSN East Cent. Afr. J. surg

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1 65 ISSN Eat Cent. Afr. J. urg Pattern and and Outcome of Surgical Management of Potrenal Acute Renal Failure Over Three Year Period at Tikur Anbea Specialized Hopital. L. Samodai, D. Andualem, A. Getaew Addi Ababa Univerity, School of Medicine, Department of Surgery Correpondence to: Dr. D. Andualem, Background: Pot renal acute renal failure occur when there i an obtruction to renal flow anywhere dital to the pelvi. Method: Thi tudy wa a three year retropective analyi of patient who underwent treatment for pot renal acute renal failure patient at TASH, urology unit, from January 2010 to December Reult: The pot intervention creatinine of the patient with pot renal acute renal failure wa <1mg/dl in 7 (33%), 1-2 mg/dl in 5 (24%), 2-5mg/dl in 6 (29%) and >10mg/dl in 3 (14%) (Table 5). When we ee the general out come 12 (57%) patient have improved, 4 (19%) patient are fair (lightly improved) and 5 (24%) patient failed to improve Dicuion: In 33% of patient the pot intervention creatinine returned to normal (<1mg/dl) and in 24% of patient it returned to high normal (1-2mg/dl). Moreover the erum creatinine ignificantly decreaed in all patient except one. Thi indicate early intervention cure aute renal failure or at leat decreae the rate of progreion of acuteon-chronic renal failure. Concluion: Thi tudy clearly demontrate early intervention of pot renal acute renal failure bring a ignuificant improvement of patient depite a high erum creatinine level. While there i life there i hope Introduction Acute kidney injury (AKI) occur in 1% to 5% of all hopital admiion, and in the perioperative period ha eriou implication, being conitently aociated with (unacceptably) high mortality, morbidity and a more complicated hopital coure with aociated cot implication 1. Pot renal acute renal failure occur when there i an obtruction to renal flow anywhere dital to the pelvi. Obtruction i alway the mot likely diagnoi when there i anuria. For thi to occur, both ureter and the urethra hould be obtructed. It i commonly een in patient with retroperitoneal or pelvic pathology and abdominal ultraound i a good diagnotic tool 2, 3. Ureteric obtruction may be upected in the preence of an old or recent hitory of renal tone, gynecological, urological or pelvic urgery or radiation, or by clinical feature of abdominal neoplaia, epecially carcinoma of the cervix 4. Emergency treatment of obtructive uropathy i needed in the preence of bilateral obtruction, uroepi, uremia and hyperkalemia, peritent renal colic, worening of Hydronephroi and renal impairment (creatinine increaed, or GFR decreaed which i a more accurate). Regarding the dilemma to inert a ureteral tent (JJ tent) or a percutaneou nephrotomy, literature indicate that both procedure do not how any tatitically ignificant difference in term of efficacy 5, 6. Early relief of obtruction may cure acute renal failure due to pot renal etiology or convert the ituation of chronic renal failure from advancing progreive dieae to table renal inufficiency compatible with comfortable life. If retoration or improvement of renal function appear probable; relief of obtruction may be indicated, even though there ha been coniderable initial lo of function in patient whoe kidney function i irreveribly damaged by the underlying obtructive proce 7, 8. COSECSA/ASEA Publication -Eat & Central African Journal of Surgery. Nov/Dec 2014 Vol. 19 (3)

2 66 ISSN Eat Cent. Afr. J. urg Therefore thi tudy trie to how the importance of early intervention uing variou modalitie of treatment depite a ignificant rie in erum creatinine. There i till a controvery on the ignificance of creatinine in indicating the outcome of patient. In addition thee treatment need the collaboration of the urgeon, the anetheia team and nephrologit. Patient and Method Thi tudy wa a three year retropective analyi of patient who underwent treatment for pot renal acute renal failure at TASH, urology unit from January 2010 to December In thi tudy children under the age of 11 year were not included becaue they were treated in a eparate pediatric unit. We reviewed the medical record of twenty five patient with pot renal acute renal failure who underwent variou intervention during the three year period. Four of them had poor recording and were excluded from the tudy. In thi tudy we looked at the demographic ditribution, the preoperative diagnoi, preoperative renal function tet, the procedure they underwent, their pot operative renal function tet and their outcome. Reult We had 21 patient 16 (76%) male and 5 (24%) female with pot renal acute renal failure of which 14 (67%) i due to urolithiai followed by tumor 4 (19%), Pelviureteric junction (PUJ) obtruction 3 (9%) and bilateral ureteric ligation 1 (5%), repectively (Table 1). Their age range from 14 to 70 year with the average age being 38 year. We found different pattern of urolithiai which preented a bilateral ureterolithiai 6, unilateral ureterolithiai (UUL) with contra-lateral nephrolithiai 1, bilateral nephrolithiai (BNL) 3, unilateral nonfunctioning kidney with contra-lateral nephrolithiai or ureterolithiai (UNFK+N/UL) 3 and ureterolithiai in olitary kidney (UUL(SK)) 1, repectively (Table 2). The pot intervention creatinine of the patient with pot renal acute renal failure wa <1mg/dl in 7 (33%), 1-2 mg/dl in 5 (24%), 2-5mg/dl in 6 (29%) and >10mg/dl in 3 (14%) (Table 5). When we ee the general out come 12 (57%) patient have improved, 4 (19%) patient are fair (lightly improved) and 5 (24%) patient failed to improve (Table 6). Four patient died of uremia and urinary tract infection. Figure 1.Preoperative Diagnoi of Pot Renal Acute Renal Failure Patient COSECSA/ASEA Publication -Eat & Central African Journal of Surgery. Nov/Dec 2014 Vol. 19 (3)

3 67 ISSN Eat Cent. Afr. J. urg Figure 2.Pattern of Urolithiai Cauing Pot-renal Acute Renal Failure Figure 3. Preoperative creatinine level of pot renal acute renal failure patient Table 4.type of procedure done for the patient with pot renal acute renal failure Procedure Bilateral Unilateral Double J Stent inertion 8 4 Percutaneou Nephrotomy 3 3 Ureterorenocopy 5 4 Open Nephrotomy - 1 Open Ureterolithotomy 1 1 Ureteric reimplantation 1 - Total 18* 13* *Some patient needed more than one procedure COSECSA/ASEA Publication -Eat & Central African Journal of Surgery. Nov/Dec 2014 Vol. 19 (3)

4 68 ISSN Eat Cent. Afr. J. urg Figure 5. Potoperative Creatinine level of Pot renal Acute Renal Failure Patient Dicuion Table 6. Outcome of Pot renal Acute Renal Failure Patient After Intervention in%, n=21 Thi tudy how pot renal acute renal failure i not a rare phenomena a we have een 21 patient in three year in one unit at TASH. Like elewhere, the majority of our patient are due to urolithiai. Other caue are tumor and PUJ obtruction 4,5 7. The dieae affect patient at any age but majority are young adult with a mean age of 38 year. Urolithiai occur in different pattern cauing obtructive uropathy a a caue of acute renal failure. It can be unilateral, bilateral or may affect one ureter and the kidney itelf. In ome patient the kideney i non-excreting or already damaged. In our patient the preintervention erum creatinine i above 4mg/dl which how there wa a ignificant derangement of the renal function. COSECSA/ASEA Publication -Eat & Central African Journal of Surgery. Nov/Dec 2014 Vol. 19 (3)

5 69 ISSN Eat Cent. Afr. J. urg Many patient were treated with double J tenting and percutaneou nephrotomy which can be done under local anetheia. But in a ignificant portion of patient we did ureterocopy which require general anetheia depite the high level of erum creatinine. In 33% of patient the pot intervention creatinine returned to normal (<1mg/dl) and in 24% of patient it returned to high normal (1-2mg/dl). Moreover the erum creatinine ignificantly decreaed in all patient except one. Thi indicate early intervention cure acute renal failure or at leat decreae the rate of progreion of acute-on-chronic renal failure. Thi i very important in reource poor etting where renal replacement therapy i not readly available. Concluion Thi tudy ha hown early intervention of pot renal acute renal failure bring a ignificant improvement of patient depite a high erum creatinine level. While there i life there i hope 9. Reference 1. S. Calvert, A.Shaw, Perioperative acute kidney injury, Perioperative medicine, 2012, 1:6 2. R. Jacob, Acute Renal Failure, Indian J, Anetheia, 2003;47 (5): H. Roenblum et al, The Endle Differential Diagnoi of Acute Obtructive Renal Failure: Unuual Challenge for the Sharp-Sighted Clinician, IMAJ, 2010, Vol R. G. Luke, A. C. Kennedy, Prevention and early management of acute renal failure, Potgrad. med. J., 1967, 43: P.I. Mourmouri, T. Chira, A.G. Papatori, Obtructive Uropathy: From Etiopathology to Therapy, World J. Nephrol Urol. 2014;3(1): V. M. Ramyil et al, The Management of Upper Urinary Tract Obtruction in Reource Poor Setting, African Journal of Urology, 2006, Vol.13, No M. Shehab et al, Role of ureteric tent in relieving obtruction in patient with obtructive uropathy, Urol Ann. 2013; 5(3): J.V. Alono, Bilateral tone a a caue of acute renal failure in the emergency department (A cae report), World J Emerg Med, 2014: Vol. 5, No M. King, Primary Surgery, Trauma, 1987, Vol. 2, P. 131 COSECSA/ASEA Publication -Eat & Central African Journal of Surgery. Nov/Dec 2014 Vol. 19 (3)