Management of obstructive nephropathy in a tertiary hospital in North West Nigeria: A five-year review

Abstract

Background: Obstructive nephropathy is managed initially with urinary diversion and possibly haemodialysis before definitive therapy. This study was aimed at determining the pattern of presentation, aetiology and management options of obstructive nephropathy in our practice. Methods: This was a five-year retrospective study of the patients managed for obstructive nephropathy at our facility from January 2011-December 2015. Data were collected via a pro forma and analysed using SPSS version 20.0. Results: There were 106 patients managed for obstructive nephropathy with a mean age of 48.3 ± 17. 4 years and age range of 4 months to 85 years. The male: female ratio was 10:1. The most common causes of obstructive nephropathy were bladder cancer (49.1%), benign prostatic hyperplasia (BPH, 22.6%), bilateral ureteric stone (5.7%) and bilateral schistosomal lower ureteric obstruction (4.7%). Urethral or suprapubic catheterisation (22.6%), nephrostomy (2.8%) and dialysis (10.4%) were the initial treatments. Chemoradiation was done for the patients with bladder cancer and 17.9% of the patients had operative interventions, which included ureteroneocystostomy, open prostatectomy or transurethral resection of the prostate, and ureteroscopy + lithotripsy. Fifty-two patients (49.1%) died while awaiting dialysis and four patients (3.8%) developed end-stage renal disease. Conclusions: Bladder carcinomas, BPH, ureteric obstruction are the commonest causes of obstructive nephropathy in our practice. The initial treatment includes urinary diversion and or dialysis before definitive treatment. Keywords: obstructive nephropathy; bladder cancer; acute kidney injury; chronic kidney injury; urinary diversion; dialysis