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
DOI Link: https://doi.org/10.17656/jsmc.10193
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
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.
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).
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.
Percutaneous Nephrolithotomy, Renal Function, Renal Stone, Solitary kidney.
Wong KA, Sahai A, Patel A, et al. Is percutaneous nephrolithotomy in solitary kidneys safe?. Urology. 2013 Nov 1;82(5):1013-6.
Bucuras V, Gopalakrishnam G, Wolf JS, et al. The Clinical ResearchOffice of the EndourologicalSociety Percutaneous NephrolithotomyGlobal Study: nephrolithotomy in 189 patients withsolitary kidneys.J Endourol. 2012;26:336-341.
Handa RK, Matlaga BR, Connors BA, et al. Acute effects of percutaneous tract dilation on renal function and structure. J Endourol 2006;20:1030–1040.
Torricelli FC, Padovani GP, Marchini GS et al. Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis. IntBraz J Urol. 2015 May-Jun;41(3):496-502. doi: 10.1590/S1677- 5538.IBJU.2014.0343.
El-Tabey NA, El-Nahas AR, Eraky I et al. Long-term functional outcome of percutaneous nephrolithotomy in solitary kidney. Urology. 2014;83:1011-5
Basiri A, Shabaninia S, Mir A, Soltani MH. The safety and efficacy of percutaneous nephrolithotomy for management of large renal stones in single-versus double-functioning kidney patients. Journal of endourology. 2012 Mar 1;26(3):235-8.
Akman T, Binbay M, Tekinarslan E, et al. Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-centre experience. Urology. 2011;78:272–276.
Tok A, Ozturk S, Tepeler A, et al. The effects of percutaneous nephrolithotomy on renal function in geriatric patients in the early postoperative period. IntUrolNephrol. 2009;41:219–223.
Thomas K, Smith NC, Hegarty N et al. The Guy’s stone score– grading the complexity of percutaneous nephrolithotomy procedures. Urology 2011;78:277–81.
Goolsby MJ. National Kidney Foundation Guidelines for chronic kidney disease: evaluation, classification, and stratification. Journal of the American Academy of Nurse Practitioners. 2002 Jun 1;14(6):238-42.
Wang Y, Jiang F, Wang Y, et al. Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urologiainternationalis. 2012;88(3):307-10.
Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2004;18:715–22.
Resorlu B, Kara C, Oguz U, et al. Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. Urological research. 2011 Jun 1;39(3):171-6.
Traxer O, Smith TG, Pearle MS, et al. Renal parenchymal injury after standard and mini percutaneous nephrostolithotomy. The Journal of urology. 2001 May 31;165(5):1693-5.
Clayman RV, Elbers J, Miller RP, et al. Percutaneous nephrostomy: assessment of renal damage associated with semi-rigid (24F) and balloon (36F) dilation. The Journal of urology. 1987 Jul;138(1):203-6.
Handa RK, Willis LR, Connors BA, et al. Time-course for recovery of renal function after unilateral (single-tract) percutaneous access in the pig. Journal of endourology. 2010 Feb 1;24(2):283-8.
Segura JW, Patterson DE, Leroy AJ, et al. Percutaneous removal of kidney stones: review of 1,000 cases. The Journal of urology. 1985 Dec;134(6):1077-81
Jones DJ, Kellett MJ, Wickham JE. Percutaneous nephrolithotomy and the solitary kidney. The Journal of urology. 1991 Mar;145(3):477-9.
Canes D, Hegarty NJ, Kamoi K, et al. Functional outcomes following percutaneous surgery in the solitary kidney. The Journal of urology. 2009 Jan 31;181(1):154-60.
Sharifiaghdas F, Kashi AH, Eshratkhah R. Evaluating Percutaneous Nephrolithotomy-Induced Kidney Damage by Measuring Urinary Concentrations of &bgr-2 Microglobulin. Urology journal. 2011 Oct 1;8(4):277.
Gorbachinsky I, Wood K, Colaco M, et al. Evaluation of Renal Function after Percutaneous Nephrolithotomy—Does the Number of Percutaneous Access Tracts Matter?. The Journal of urology. 2016 Jul 31;196(1):131-6.
El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. The Journal of urology. 2007 Feb 1;177(2):576-9.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.