The relative contribution of urine extravasation to elevation of plasma creatinine levels in acute unilateral ureteral obstruction

Authors

  • Barak Rosenzweig Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013 The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
  • Jehonathan H Pinthus Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
  • Nir Kleinmann Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Erel Joffe School of Biomedical Informatics, University of Texas Health Science Center, Houston Texas
  • Tomer Erlich Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Eddie Fridman Department of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Harry Winkler Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Yoram Mor Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Jacob Ramon Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel
  • Zohar A Dotan Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel

DOI:

https://doi.org/10.5489/cuaj.2804

Keywords:

ureteral obstruction, urine extravasation, acute renal failure, pseudo renal failure, spurious renal failure.

Abstract

Introduction: Rising levels of plasma creatinine in the setting of acute unilateral ureteral obstruction (AUUO) often reflects acute renal failure, mandating kidney drainage. We hypothesize that reabsorption of peri-renal urine extravasation (PUE), a common result of UUO, contributes significantly to the elevation in plasma creatinine, rendering the latter an inaccurate benchmark for renal function. We explored this hypothesis in a rat model of AUUO and PUE.

Methods: In total, 20 rats were equally divided into 4 groups. Groups 1 and 2 underwent unilateral ligation of the ureter with infiltration of rat’s urine (index group) or saline (control) into the peri-renal space. Two additional control groups underwent perirenal injection of either urine or saline without AUUO. Plasma creatinine levels were determined immediately prior to the procedure (T0), and hourly for 3 hours (T1, T2 and T3). Renal histology was investigated after 3 hours.

Results: Rats in the index group had a significantly greater increase in plasma creatinine levels over 3 hours compared to all other groups (p < 0.05). At T3, average plasma creatinine levels for the index group increased by 96% (0.49 ± 0.18 mg/dL) compared to 46% (0.23 ± 0.06 mg/dL increase) in the AUUO and saline group, and less than 15% rise in both the non-obstructed control groups. Our study limitations includes lack of spontaneous PUE and intraperitoneal surgical approach.

Conclusions: Absorption of peri-renal urine in the presence of AUUO is a significant contributor to rising plasma creatinine levels, beyond those attributable to the obstruction alone, and may overestimate the extent of the true renal functional impairment.

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Author Biography

Barak Rosenzweig, Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Sackler School of Medicine, Tel-Aviv University, Israel The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013 The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

Urology resident

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Published

2015-07-17

How to Cite

Rosenzweig, B., Pinthus, J. H., Kleinmann, N., Joffe, E., Erlich, T., Fridman, E., Winkler, H., Mor, Y., Ramon, J., & Dotan, Z. A. (2015). The relative contribution of urine extravasation to elevation of plasma creatinine levels in acute unilateral ureteral obstruction. Canadian Urological Association Journal, 9(7-8), E428–33. https://doi.org/10.5489/cuaj.2804

Issue

Vol. 9 No. 7-8 (2015): CUAJ July

Section

Original Research

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