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Abstract

Objective: To compare the pathological and clinical outcomes of percutaneous nephrostomy (PCN) versus double-J (DJ) stent placement in restoring renal function in obstructive uropathy secondary to urolithiasis, focusing on mechanisms of tubular injury, fibrosis, and inflammatory response.
Material and Methods: A randomized clinical trial (March–September 2023) included 200 patients (100 PCN, 100 DJ stent) with obstructive uropathy due to urolithiasis. Inclusion criteria: age 18–75 years, elevated serum creatinine (>1.03 mg/dL males; >1.1 mg/dL females), and urea (>20 mg/dL). Renal function normalization time (hours) was measured post-intervention. Quantitative variables (age, stone size/duration, BMI) were analyzed using independent t-test/Mann-Whitney U test. Pathological correlates included TGF-β-mediated fibrosis, angiotensin II activity, and mononuclear leukocyte infiltration.
Results: PCN demonstrated significantly faster renal recovery (100.20 (15.41) hours vs. DJ stent: 109.40 (15.15) hours, p=0.001). Stratified analysis revealed prolonged obstruction (>10 days) exacerbated interstitial fibrosis in DJ stent patients (117.29 (7.67) hours vs. PCN: 108.14 (7.75) hours, p=0.001). Diabetic patients exhibited delayed normalization (PCN: 106.17 (6.52) hours; DJ: 117.00 (8.25) hours, p=0.001), correlating with heightened oxidative stress.
Conclusion: PCN accelerates renal function recovery by mitigating pathological cascades (ischemia, TGF-β-driven fibrosis, and cytokine release) more effectively than DJ stents. These findings highlight the role of rapid decompression in reducing chronic tubulointerstitial damage.
Keywords:  Inflammatory cytokines, Obstructive uropathy, Percutaneous nephrostomy, Renal ischemia, Tubulointerstitial fibrosis, Urolithiasis.