The management of renal stone disease in the presence of chronic kidney disease is a challenging scenario, both in terms of surgical safety as well as perioperative outcomes. The aim of the present study is to study the efficacy, safety, and outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease.
A prospective study was conducted including adult patients with renal stone disease and a creatinine clearance of <90ml/min (Stage 2 CKD or more) who underwent percutaneous nephrolithotomy. Pre-operative and post-operative serum creatinine and glomerular filtration rates were compared. Patients were divided into CKD stages 1-5 having creatinine clearance >90ml/min, 60-90ml/min, 30-60ml/min, 15-30ml/min and <15ml/min respectively. Based on up migration or down migration of CKD stages, patients were classified as improved, deteriorated or stable. Peri-operative complications and outcomes were also compared.
A total of 185 patients with CKD stage less than or equal to 2 underwent PCNL. The mean age of the patients was 43.24+/-14.32 years. The mean preoperative estimated glomerular filtration rate was 62.88±23.42mL/min/1.73m2. Pre-operative CKD stage distribution was as follows: stage 2-121(65.4%), stage 3-34(18.4%), stage 4-24(13%) and stage 5-6(3.2%). On last follow-up of patients, the mean creatinine was 1.07±0.65 mg/dL and the mean eGFR was 82.75±31.22 mL/min/1.73m2. The median change in creatinine and mean change in GFR was 0.23 (0.16-0.27) g/dL and 19.87 ± 19.77 mL/min/1.73 m2 respectively. Improvement in kidney function with a stage down migration was seen in 115 cases(62.2%), slight improvement with no change in stage in 69 cases(37.3%) and deterioration of CKD stage was present in one case(0.5%).
Percutaneous nephrolithotomy is associated with favourable functional outcomes in chronic kidney disease patients including severe CKD(stage IV and V). Improvement or stabilization of CKD stage was seen in 99.5% patients post PCNL.
Journal of endourology. 2021 Dec 03 [Epub ahead of print]
Harkirat Singh Talwar, Ankur Mittal, Vikas Kumar Panwar, Jyoti Mohan Tosh, Gurpremjit Singh, Rohit Ranjan, Rudra Prasad Ghorai, Sunil Kumar, Shivcharan Navriya, Àrup Mandal
All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Virbhadra, Rishikesh, Rishikesh, India, 249203; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India; ., All India Institute of Medical Sciences - Rishikesh, 442339, Urology, Rishikesh, Uttarakhand, India; .