Pediatric Pyeloplasty in the Poor Function Kidneys: Does Surgical Success Guarantee Improvement in Renal Function? Single-Center Experience and Review of Literature.

PURPOSE: To investigate the effect of pyeloplasty in pediatric patients with poor function kidneys, focusing on the split renal function (SRF) and anteroposterior diameter (APD) of the renal pelvis. MATERIALS AND METHODS: A retrospective study included 47 pediatric patients with ureteropelvic junction obstruction (UPJO) who underwent open pyeloplasty with SRF< 20%. All patients were recruited from the Labbafinejad University Hospital center from April 2014 to October 2020. The results of preoperative ultrasonography and Diethylenetriamine pentaacetate (DTPA) scan compared with the results of the ultrasonography and DTPA scan 6 months and one year after surgery. Finally, Wilcoxon signed-rank test was used to test differences the SPSS (version 25) software statistical computer package. RESULTS: The mean age of participants was 1.5 years. There were 34 cases with SRF between 10% and 20%, and 13 cases with SRF < 10%. The findings showed that pyeloplasty for UPJO leads to a significant improvement in renal function in poorly functioning renal units with 10% ≤ SRF < 20%. Although improvement in renal function occurred in the group with SRF of less than 10%, it was not statistically significant. The APD in both groups was statistically significantly improved. No correlation between genders and outcomes was found. CONCLUSION: Poorly functioning renal unit (SRF < 20%) can show functional improvement after the pyeloplasty.

Comparison of the Serum Electrolyte Levels among Patients Died and Survived in the Intensive Care Unit.

BACKGROUND: This study aimed to evaluate the prevalence of serum sodium and potassium disorders and assess their effects on mortality rate in hospitalized patients in the ICU and also to identify prognosis and predictors of survival. MATERIALS AND METHODS: A retrospective case-control study was conducted on 457 hospitalized patients in the ICU of Rasoul-e-Akram Hospital (Tehran, Iran). There were two groups: 239 patients who died in the ICU(cases) and 218 patients who were discharged from the ICU(controls). Normal serum concentrations of sodium and potassium were considered as 135-150 and 3-5.5 mEq/L, respectively. Data were analyzed using Chi square test, Independent t-test, One Way ANOVA, Correlation and Receiver Operating Characteristic (ROC) curve. RESULTS: The mean serum sodium concentration in patients who died and discharged patients was 137.56(SD=8.56) and 137.17(SD=5.11) mEq/L, respectively. Whereas, hyponatremia was significantly more common in expired patients (39.7% vs. 28%, P<0.001). On the other hand, the mean serum potassium concentration in expired and discharged patients was 4.42(SD=0.90) and 4.16(SD=0.59)mEq/L, respectively. Hyperkalemia was significantly more common in expired patients (9.2% vs. 0.9%, P<0.001). There was a significant negative correlation between serum sodium concentration and patient's age (P=0.029, R Spearman = - 0.123). In addition, ROC analysis showed that serum potassium concentration could potentially be a predictor of death in ICU patients (P=0.003, Area Under Curve (AUC) = 0.581). CONCLUSION: Hyponatremia and hyperkalemia are highly prevalent in expired ICU patients which is compatible with the findings of some other studies. Mortality of ICU patients is linked, in greater part, to organ dysfunction, but the severity of serum sodium and potassium disturbances remains a significant predictor of mortality. Thus, correcting electrolyte disturbances in ICU patients is important.