The Characteristics and Outcomes of Patients Treated with Percutaneous Nephrolithotomy According to the Preoperative Renal Function Levels

Abstract

Introduction The principles of nephrolithiasis therapy in patients with chronic kidney disease are the same as in patients with normal kidneys. Percutaneous nephrolithotomy (PNL) is the standard treatment for patients with complex or large-volume upper urinary tract calculi. We reported the characteristics and outcomes of patients following percutaneous nephrolithotomy according to their preoperative renal function levels. Methods In this prospective cohort study, data on 53 consecutive patients treated with percutaneous nephrolithotomy in 6 months were collected. Patients were divided into 3 groups by estimated glomerular filtration rate (eGFR) including chronic kidney disease (CKD) stages 0, 1 and 2 (eGFR ≥ 60 mL/min/1.73 m2), stage 3 (eGFR = 30 to 59 mL/min/1.73 m2) and stages 4 and 5 (eGFR < 30 mL/min/1.73 m2). Results 31 patients with CKD stages 0, 1, and 2, 17 patients with CKD stage 3, and 5 patients with stages 4 and 5 were followed up for at least three months. The mean eGFR before and after PNL was 80.1 vs. 85.9, 47.6 vs. 49.1, and 23.5 vs. 23.4 mL/min/1.73 m2 in the mild, moderate, and severe CKD groups, respectively. Based on the statistical analysis, eGFR in the mild group had been significantly increased compared to the other groups, whereas there was no considerable difference between the moderate and severe groups. Conclusions By the removal of kidney stones, the progression of CKD may be halted. While significant improvement was observed in early-stage CKD, sometimes unexpected deterioration could occur in patients at the end stages of renal diseases.

Keywords

• nephrolithiasis
• renal insufficiency
• chronic
• nephrolithotomy
• percutaneous