How is Dietl’s Crisis linked to renal function?

Dietl’s Crisis may manifest at an earlier age in children with prenatally detected hydronephrosis, a recent study has found. The duration of the Dietl’s Crisis attack and anteroposterior diameter (APD) appear to be correlates of impaired differential renal function (DRF).

Using a DRF cut-off value of 40 percent, researchers divided the 143 enrolled participants (age at first onset, 5.53±2.63 years; 84.67 percent male) into two: DRF ≥40 percent and <40 percent. All included patients had undergone unilateral dismembered pyeloplasty and had at least one episode of Dietl’s Crisis before the operation.

The average DRF before surgery was 41.03±10.59 percent, and this was nominally higher in those with vs without prenatal hydronephrosis (41.37±10.63 percent vs 40.58±10.98 percent; p=0.692). Moreover, those whose hydronephrosis was detected prenatally developed Dietl’s Crisis significantly earlier (4.58 vs 5.87 years; p=0.002).

The duration of the pain of a single Crisis attack ranged from 10 minutes to 72 hours, with a median value of 2 hours. However, Wilcoxon’s rank sum test found that children who had DRF <40 percent experienced significantly longer attacks than their counterparts with DRF ≥40 percent (4 vs 2 hours; p=0.032).

The average maximum and minimum APD were 37.27±12.92 and 17.44±6.97 mm, respectively. Maximum APD was measured during or right after a Crisis attack, when the pain was still present, and the minimum was measured when pain had completely resolved. Researchers found that patients with DRF <40 percent had significantly greater peak APD (p=0.001).

Multivariate logistic regression analysis confirmed that maximum APD (p=0.018) and the duration of a Dietl’s Crisis attack (p=0.023) were significantly associated with DRF <40 percent.