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논문분류	춘계학술대회 초록집
제목	Clinical characteristics and Outcomes of obstructive uropathy
저자	Bong Gyun Sun, Jihyun Yang, Se Won Oh, Myung-gyu Kim, Shin Young Ahn, Gang Jee Ko, Jin Joo Cha, Sang-Kyung Jo
출판정보	2020; 2020(1):
키워드	AKI \| obstructive uropathy \| nephrolithiasis \| malignancy \| PCN
초록	Urinary tract obstruction (UTO) is a common clinical problem. Unlike the pediatric population in which congenital anomalies of urinary tract account for a majority of UTO and contribute to end-stage renal disease (ESRD), etiologies, clinical manifestation and outcome in adult UTO remain uncertain. This is a Multi-center, a retrospective study analyzing 1,711 patients undergoing percutaneous nephrostomy (PCN) from 2001 to 2015. The most common cause of UTO was malignancies (55.6%) followed by urolithiasis (28.5%) and others. Patients with UTO caused by malignancies were older, had more advanced stage acute kidney injury (AKI) and higher mortality rate, while those with urolithiasis had a higher prevalence of hypertension, diabetes, cardio-cerebro-vascular diseases. Eighty-two percentage of patients had AKI and 15.2% of patients needed temporary dialysis. Malignancy, higher leukocyte count, uric acid level and lower total CO2 level were independently associated with AKI. Among patients with AKI, 40.3% patients showed a renal functional recovery on day 7 after PCN. Older age and lower hemoglobin level were independent factors predicting a nonrecovery. During the median follow up 20 months, the overall mortality rate was 33.9% with the highest rate in malignancy-associated UTO (51.9%), followed by other causes (15.9%) and urolithiasis (8.8%). Stage 3 AKI and lower albumin level were independent predictors of mortality only in non-malignant cause UTO. The presence or severity of AKI did not affect the mortality in malignancy-associated UTO. Upper UTO in adults is mainly caused by malignancies, urolithiasis and substantially contribute to AKI and mortality. Factors associated with mortality vary according to different etiologies of UTO and stage 3 AKI is an independent risk factor leading to increased mortality only in non-malignant causes of UTO. A larger prospective study of patients with UTO needs to be done to understand better and also to develop strategies for optimal management UTO.
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