Renal function is based on the fixed number of nephrons, which may not be newly formed
Renal function (measured as GFR) is a function of numbers of functional nephrons. The number of nephrons are fixed (depletes with age) and none of the surgical procedure can improve the renal function.
Pyeloplasty, done for relieving the uretero-pelvic junction obstruction, decompresses the outflow system causing an apparent increase in the GFR seen on nuclear scintigraphy. Another way to look at it is- in the absence of surgery, the obstructed system will lead to irreversible progressive loss of renal function and a fall in GFR. So by preventing a fall in the GFR, pyeloplasy has improved the renal function.
I hope I have answered your question.
Vishal Singh
Thanks Dr Singh. As you agreed on the fixed number of nephrons, the scintigraphy should actually show functional 'preservation' rather than increase. Given the fact that the ROI is drawn during scintigraphy, after pyeloplasty, usually the baggy pelvis ends up tapered and would be expected to be 'reduced' proportionate to the preop study. So is the 'increase' in split function after successful pyeloplasty, a true increase?
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