Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?

Rabea Ahmed Gadelkareem, Ahmed Mahmoud Abdelraouf, Ahmed Mohammed El-Taher, Abdelfattah Ibrahim Ahmed
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Abstract

There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.

双侧恶性输尿管梗阻导致急性肾损伤:有最佳引流方式吗?
众所周知,恶性肿瘤与肾功能损害(急性肾损伤或慢性肾病)之间存在着密切关系。然而,在前者中,双侧恶性输尿管梗阻是这一复杂病理的一个可通过手术矫正的因素。在急诊情况下,需要对肾脏进行紧急引流。然而,关于这些患者双侧梗阻肾脏的最佳引流方式存在多种争议和争论。本综述探讨了其中的大部分问题,并从最新文献中对这一主题进行了全面介绍。此外,我们还从不同角度探讨了恶性肿瘤导致的双侧肾脏梗阻的处理方法。尽管为提高输尿管支架的成功率和功能进行了频繁的试验,但置入经皮肾造瘘管仍是双侧输尿管梗阻引流的最推荐工具,尤其是在晚期恶性肿瘤患者中。然而,对这些患者生活质量的影响仍是一个尚未解决的主要问题。除了潜在恶性肿瘤的不利预后潜能和已提出的各种风险分层模型外,还可以通过多种肾脏预后因素来预测和评估肾脏对初始引流的反应,包括尿量增加、血清肌酐轨迹和引流后血清肌酐达标时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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