The effect of percutaneous nephrolithotomy in patients with chronic kidney disease in northeast India population
DOI:
https://doi.org/10.18203/2349-2902.isj20211807Keywords:
CKD, Endourology, PCNLAbstract
Background: Renal stone disease is a recognized precursor for renal deterioration, if untreated, it can lead to renal failure. With advances in the PCNL technique, it's effect on patients with established renal insufficiency remains under reported. So, we aimed to evaluate the efficacy as well as safety of PCNL in chronic kidney disease patients.
Methods: This retrospective cohort study included patients admitted to our hospital from January 2016 to December 2018, which were diagnosed with urolithiasis and chronic kidney disease and treated by PCNL. Patients with GFR <60 ml/min/1.73 m2 in the non-obstructed renal stone disease who underwent PCNL were included. We studied the change in renal function, complete stone free rate (SFR), complications, stone composition, operative time and hospital stay.
Results: The study comprised 50 patients (M/F-32/18) Of CKD who underwent PCNL. Mean operative time was 90.50±12.57minutes in group 1 and 98.00±12.35 minutes in group 2. One or more complications were noted in 12 patients (24%) after PCNL. At a mean follow-up of 18 months, renal function stage had improved in 24 patients (48%) and it was maintained in 13 (26%). Worsening of CKD with an increase in disease stage was noted in 13 patients (26%). Association between hypertension, diabetes, and postoperative deterioration in kidney function wasn’t significant statistically (p=0.9). The stone-free rate at postoperative month 3 was 76%.
Conclusions: PCNL has a favourable outcome in patients with chronic kidney disease stage III/IV, with a good calculus clearance rate and improved kidney function.
References
Rule AD, Bergstralh EJ, Melton LJ, Li X, Weaver AL, Lieske JC. Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol. 2009;4:804-11.
Gupta M, Bolton DM, Gupta PN, Stoller ML. Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol 1994;152:1086-90.
Marangella M, Bruno M, Cosseddu D, Manganaro M, Tricerri A, Vitale C, et al. Prevalence of chronic renal insufficiency in the course of idiopathic recurrent calcium stone disease: risk factors and patterns of progression. Nephron. 1990;54(4):302-6.
Alexander RT, Hemmelgarn BR, Wiebe N, Bello A, Morgan C, Samuel S, et al. Kidney stones and kidney function loss: a cohort study. BMJ. 2012;345:e5287.
Keddis MT, Rule AD. Nephrolithiasis and loss of kidney function. Curr Opin Nephrol Hypertens. 2013;22(4):390-6.
Keddis MT, Rule AD. Nephrolithiasis and loss of kidney function. Curr Opin Nephrol Hypertens. 2013;22(4):390-6.
Kurien A, Baishya R, Mishra S, Ganpule A, Muthu V, Sabnis R, et al. The impact of percutaneous nephrolithotomy in patients withchronic kidney disease. J Endourol. 2009;23:1403.
Kukreja R, Desai M, Patel SH, Desai MR. Nephrolithiasis associated with renal insufficiency: factors predicting outcome. J Endourol. 2003;17(10):875-9.
Akman T, Binbay M, Aslan R, Yuruk E, Ozgor F, Tekinarslan E, et al. Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol. 2012;187(1):173-7.
Akdeniz E, Bolat MS, Şahinkaya N. Treatment of renal stones with percutaneous nephrolithotomy improves renal functions in chronic kidney disease patients. Int J Surg Med. 2016;2(1):30-3.
