FUNCTIONAL IMPROVEMENT AFTER PERCUTANEOUS NEPHROLITHOTOMY IN THE SOLITARY KIDNEY PATIENTS 

Hthayyim Khalid Ahmed a, Mohammed Abed Al Kadum Hassan a, Sarwar Noori Mahmood b, Ismaeel Aghaways b, Rawa H Ghareeb a and Dlshad Hama Khurshid a



a Urology Department, Sulaimani Surgical Teaching Hospital. 
b Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 


Submitted: 25/12/2018; Accepted: 3/5/2019; Published: 21/6/2019

ABSTRACT


Background 

Percutaneous nephrolithotomy is regarded as the treatment of choice for large and complex renal stones. Despite of its safety and efficacy, it remains a crucial challenge for endourologist in soiltary kidney patients


Objectives 

To assess the effect of percutaneous nephrolithotomy (PNL) on renal function measured by glomerular filtration rate (GFR) in solitary kidney patients


Materials and Methods

The records of 25 patients with age range of (18-66) years with a solitary functioning kidney that had undergone PNL from September 2015 October 2017 in Sulaymani Teaching Hospital were prospectively analyzed. Serum creatinine was measured preoperatively and 7 days postoperatively. Preoperative, operative and postoperative details were analyzed for each patient with respect to change in eGFR between pre and postoperative period. Multivariate analysis was done to find relations between variable, p-value < 0.05 was considered as significant.


Results

There was a significant increase in the mean postoperative eGFR in (P-value <0.001). Age, gender, BMI, DM, history of ipsilateral renal surgery, grade of hydronephrosis, stone complexity and location have no considerable impact on postoperative renal function impairment (p-value >0.05). Operative time, the number of working tracts and the size of amplatz sheath also have no impact on the deterioration of renal function. Hypertension caused a significant decrease in the postoperative eGFR (p-value 0.01) and blood loss more than average (Hb drop >1.072gm/dl) caused either stable or decrease in the postoperative eGFR (P-value 0.03).


Conclusion

Percutaneous nephrolithotomy is safe in solitary kidney patients and early renal function improvement is anticipated. History of hypertension and bleeding are the two blamed risk factors that cause acute postoperative renal function deterioration.



KEYWORDS

Percutaneous Nephrolithotomy, Renal Function, Renal Stone, Solitary kidney.