What is the role of surgery in the treatment of azotemia?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

If hydronephrosis is due to ureteral obstruction, unilateral or bilateral stenting or percutaneous nephrostomy is performed. Recovery of renal function takes 7-10 days, but renal function may be severely impaired, necessitating dialysis until such time as partial recovery is adequate for withdrawal of dialysis.

Up to 500-1000 mL/min of postobstructive polyuria can be seen with relief of obstruction. This is an appropriate response and represents an attempt to excrete the excess fluid accumulated during the period of obstruction.

Because of salt wasting during this phase, dehydration and hypokalemia are likely. Thus, two thirds of the urine output should be replaced with half-normal saline and potassium chloride if the patient is hypokalemic. Close monitoring is indicated to prevent hypotension and prerenal azotemia.

Matching the hourly urine output with IV replacement fluid is not recommended, because the excess water retained during the period of obstruction cannot be offloaded if hourly urine output is matched.


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