Urinary Diversion. Long-term renal function and morphology and consequences for metabolism

Research output: ThesisDoctoral Thesis (compilation)

Abstract

In a long-term prospective follow-up in patients randomized to an ileal or colonic conduit, with implantation of one ureter using antireflux technique and the other without, the fall in the mean total GFR exceeded the expected age-related decline. The fall in the mean separate GFR did not differ between refluxing and antirefluxing anastomosis. Patients with a continent caecal reservoir (antireflux anastomosis) compared favourably with those who had undergone a conduit urinary diversion. Severe renal scarring was associated with refluxing ureteric implantation in most patients. The fall in the preoperative mean separate GFR was significantly greater in kidneys with moderate or severe scarring than in those with no or only slight scarring ( p = 0.017 ). In an experimental study refluxing ureteric implantation in a low-pressure enterocystoplasty was commonly associated with bacteriuria in the upper urinary tract and pyelonephritis. The findings imply that an antireflux ureteric implantation is of significant importance in patients undergoing urinary diversion.

Renal tubular dysfunction, slight in most cases, was found in 36% of patients after urinary diversion by determining the urinary levels of protein HC. In patients with well-preserved GFR the fall in the preoperative mean GFR was greater in those with elevated levels of protein HC than in those with normal levels ( p< 0.01 ) indicating that protein HC may be a suitable marker for detecting early renal impairment after urinary diversion.

In a group of patients with a colonic reservoirs and a moderate renal impairment a slight hyperchloremic metabolic acidosis was noticed in few patients at long-term follow-up. Calcium homeostasis was also influenced, with lower levels of ionized calcium found in the renal impairment group.

Details

Authors
  • Ársæll Axel Kristjánsson
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology

Keywords

  • metabolism, bacteriuria, renal scarring, refluxing and antirefluxing ureteric anastomosis, tubular dysfunction, Urinary diversion, glomerular filtration rate, acid-base homeostastis, Urology, nephrology, Urologi, nefrologi
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date1996 Nov 15
Publication statusPublished - 1996
Publication categoryResearch
Externally publishedYes

Bibliographic note

Defence details Date: 1996-11-15 Time: 10:15 Place: Centralblocket University Hospital, Lund External reviewer(s) Name: Djurhuus, Jens C Title: Prof Affiliation: Institut for Eksperimentell klinisk Forskning ---