The role of early nephrostomy in the management of patients with hyperkalaemia and renal failure due to ureteric obstruction

ObjectiveTo assess the outcomes of early percutaneous nephrostomy in obstructed hydronephrosis and hyperkalaemia from ureteric obstruction.MethodsPatients were diagnosed with hyperkalaemia with serum potassium >5.0 mmol/L and hyperkalaemia was graded as mild (5.0–6.0 mmol/L), moderate (6.1–7.0 mmol/L) or severe (>7.1 mmol/L). Data on age, sex, clinical presentation, presence of concurrent disease, creatinine, potassium, haemoglobin concentration, time interval in doing the nephrostomy since their first presentation, any prenephrostomy medical correction of hyperkalaemia and complications were collected.ResultsA total of 61 patients (40 males and 21 females) with mean age of 69.7 years (ranged 35 to 94 years) underwent 69 procedures. Prior to the nephrostomy, the serum potassium was mildly elevated in 42 cases, moderately elevated in 17 cases and severely elevated in 10 cases. The overall mean level of potassium before intervention was 6.1 mmol/L (range: 5.1 mmol/L-9.3 mmol/L). Forty (58%) had nephrostomy without prior medical treatment of the hyperkalaemia. The mean serum potassium in these patients was 5.6 mmol/L (range: 5.1 mmol/L-7.5 mmol/L). Twentynine (42%) had medical treatment of the hyperkalaemia prior to nephrostomy. The mean potassium level in these patients was reduced from 6.7 mmol/L (range 5.4 mmol/L-9.3 mmol/L) before medical treatment to 5.8 mmol/L (4.0 mmol/L-7.4 mmol/L). Five patients (7%) had complications from percutaneous nephrostomy including temporary atrial fibrillation in 3 patients and transient pyrexia in 2 patients.ConclusionsPercutaneous nephrostomy as the initial management for hyperkalaemia from ureteric obstruction is a safe procedure with acceptable complication rates.