A prospective study assessing feasibility of performing percutaneous nephrolithotomy in chronic kidney disease patients - What factors affect the outcome?

Abstract

Objectives To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL.Materials and Methods Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0–2] were included in the study.Results A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not significant enough to cause stage migration. Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not significant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the final follow up visit (6 months).Conclusion Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.

Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

“…This may be because impairment of renal function in the absence of significant perioperative complications appears to be minimal, transient and focal. Effect on renal function is influenced by preoperative renal status and presence of comorbidities such as diabetes mellitus and hypertension [15]. Violation of the renal parenchyma, high irrigation pressure, tract multiplicity, preoperative urine infection and postoperative bleeding are reported as attributes causing post-PNL AKI [2,16].…”

“…Violation of the renal parenchyma, high irrigation pressure, tract multiplicity, preoperative urine infection and postoperative bleeding are reported as attributes causing post-PNL AKI [2,16]. However, subsequent improvement in renal function is seen in almost all renal units that are obstructed and infected [15,17]. Standardized definition of AKI was introduced to aid early detection and management and improve the overall patient outcomes [3].…”

Percutaneous Nephrolithotomy in Patients with Chronic Kidney Disease: A Systematic Review

“…GFR was utilized to gauge changes in renal function in 7 studies [2,10,12,[15][16][17][18]. Mean pre-operative, postoperative, and follow-up eGFR in these studies were observed to be 38.23, 47.23, and 45.33 mL/min/1.73 m 2 , respectively.…”

“…Chronic kidney disease (CKD) is emanating as a significant chronic health problem globally [1]. As per the Kidney Disease Outcomes Quality Initiative (K/DOQI) Advisory Board, CKD is defined as sustained kidney injury for >3 months with GFR <60 mL/min/1.73 m 2 [2]. In the USA, there were 6, 87,093 patients with end-stage re- nal disease at the end of 2015 [3].…”

“…Different studies have evaluated the effect of PCNL on renal function and complications in patients with CKD. Most of the patients with CKD had improvement or stabilization in overall renal function, while some had deterioration [2,10,[12][13][14]. With this background, assessing the impact of PCNL in CKD patients is of utmost significance.…”