Клинический разбор в общей медицине (Jun 2024)
Renal hemodynamic changes and kidney function in the first day after percutaneous nephrolithotripsy
Abstract
Background. Over the past decade, percutaneous nephrolithotripsy (PNL) has become one of the most popular treatments for urolithiasis. The reason is the high efficiency of the method in combination with a low incidence of complications and a shorter period of hospitalization. However, the effect of PNL on renal function has not been sufficiently studied. The aim of this study was to evaluate changes in renal hemodynamics and kidney function in the early postoperative period after PNL. Patients and Methods. The clinical data of 18 patients who underwent PNL were analyzed. Serum creatinine levels were determined in all patients before and after PNL, glomerular filtration rate was calculated, and ultrasound examination of the kidneys with dopplerography of renal blood flow was performed. The size, density of the stone and its localization in the kidney were determined using computed tomography. Results. The average size of the stones was 224.4±38.5 mm2, the average density was 1152±76 HU. The duration of surgical intervention is 96.1±9.2 minutes. In 7 patients after PNL, creatinine levels decreased compared to preoperative, while in the remaining 11 patients, creatinine levels increased in the early postoperative period (p<0.001). Acute kidney injury developed in three patients (16.7%): there was an increase in creatinine concentration by 40.7±11.7 mcmol/l compared with the baseline level. In patients with both improved renal function on the first day after surgery and with deterioration of function, the same type of changes were revealed. There was an increase in vascular resistivity. This does not allow the use of dopplerography of renal blood flow as prognostic predictors of impaired renal function. Unlike the duration of the intervention, the size of the stone remains the main predictor of the risk of acute kidney injury after PNL.
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