Obstructive uropathy (OU) is a common urological emergency associated with significant morbidity. Prompt urinary tract diversion via Double J (DJ) stenting or percutaneous nephrostomy (PCN) is critical for renal function preservation. However, predicting renal recovery post-diversion remains clinically significant. This study aims to identify factors influencing renal function recovery following urinary diversion in acute obstructive uropathy.

This prospective observational study included 177 patients aged ≥16 years with acute OU (bilateral or unilateral with a solitary kidney) and serum creatinine >2 mg/dL, undergoing urinary diversion (DJ stenting, PCN, PUC, or SPC). Patients with known chronic kidney disease or congenital anomalies were excluded. Key factors analyzed included preoperative serum creatinine, symptom duration, diversion type, complications, hemodialysis need, hospital stay, and comorbidities. Renal recovery was defined as serum creatinine ≤1.5 mg/dL at 4 weeks post-diversion. Data were analyzed using SPSS v23 (p<0.05).

Renal recovery was achieved in 59.9% of patients. Significant predictors of recovery included younger age (≤60 years, p=0.046), absence of diabetes and hypertension, hemoglobin >12 g/dL, symptom duration ≤4 weeks (p<0.001), lower baseline serum creatinine (p<0.001), mild hydronephrosis, and preserved corticomedullary differentiation (p<0.001). Non-recovery was associated with prolonged obstruction, hemodialysis requirement, and severe renal parenchymal loss.

Younger age, shorter symptom duration, and favorable renal function markers predict renal recovery post-diversion. Long-term follow-up is vital to manage complications and ensure renal stability. Timely intervention and identifying predictive factors are crucial in optimizing renal recovery post-urinary diversion.