|
1
|
Navriya S, Singh V, Sharma K, Bhirud DP, Singh M, Choudhary GR, Sandhu AS. Predictive factors for functional improvement and assessment of outcomes in CKD patients after PCNL. Urologia 2025:3915603251317042. [PMID: 39925225 DOI: 10.1177/03915603251317042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Abstract
INTRODUCTION Patients with urinary stone disease may present with CKD. The incidence of developing end stage renal disease (ESRD) in patients with renal calculi is 0.2%-3.2%. In the present study we aim to discuss outcomes of PCNL in CKD patients. MATERIALS AND METHODS This was a prospective observational study done, from January 2023 to March 2024. Data of 96 CKD patients with renal stones who underwent standard PCNL were recorded. Patients were followed up with urinalysis, serum creatinine and ultrasound KUB. Preoperative eGFR were compared with eGFR 36 months follow up. Patients were divided into two groups. Group 1- improved and group 2- stable or worsened disease since the final follow up visit. OBSERVATIONS AND RESULTS After PCNL renal function improvement was seen in 52 (54%) patients that is, Group I & in 44 (46%) patients it was stable or declined that is, Group II. In Group I, mean preoperative eGFR was 41.13 ± 14.23 ml/min/m2 which improved to 46.91 ± 12.14. In Group II mean preoperative eGFR was 37.14 ± 12.32 which declined to 33.17 ± 12.57. The statistically significant factor decreasing the efficacy of PCNL in CKD patients were presence of co morbidities (Hypertension, DM; p = 0.007), staghorn stones (p = 0.001), history of previous renal surgery (p = 0.001), operation time > 100 min (p < 0.0001), post PCNL stone free status(p < 0.0001), and Complications(p = 0.03). After 6 months follow up 8 patients in Group I shifted from CKD stage 4 to CKD stage 3 and four patients in group II shifted from CKD stage 3 to CKD stage 4. CONCLUSION Factors like presence of comorbidities, staghorn calculus, previous surgery operative time and post operative complications affects improvement of renal function in CKD patients after stone clearance.
Collapse
Affiliation(s)
- Shivcharan Navriya
- All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | - Vikram Singh
- All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | - Kartik Sharma
- All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | | | - Mahendra Singh
- All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| | | | - Arjun Singh Sandhu
- All India Institute of Medical Sciences - Jodhpur, Jodhpur, Rajasthan, India
| |
Collapse
|
|
2
|
Herout R, Putz J, Borkowetz A, Thomas C, Oehlschläger S. Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay. Int Urol Nephrol 2023; 55:3039-3044. [PMID: 37615842 PMCID: PMC10611860 DOI: 10.1007/s11255-023-03749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors. METHODS Billing data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed. RESULTS 2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort. CONCLUSION For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.
Collapse
Affiliation(s)
- Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Juliane Putz
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sven Oehlschläger
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| |
Collapse
|
|
3
|
Talwar HS, Mittal A, Panwar VK, Tosh JM, Singh G, Ranjan R, Ghorai RP, Kumar S, Navriya S, Mandal À. Efficacy and safety of percutaneous nephrolithotomy in patients with chronic kidney disease: Outcomes from a tertiary care center. J Endourol 2021; 36:600-609. [PMID: 34861766 DOI: 10.1089/end.2021.0514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS 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%). CONCLUSION 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.
Collapse
Affiliation(s)
- Harkirat Singh Talwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Ankur Mittal
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Vikas Kumar Panwar
- All India Institute of Medical Sciences - Rishikesh, 442339, Virbhadra, Rishikesh, Rishikesh, India, 249203;
| | - Jyoti Mohan Tosh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Gurpremjit Singh
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rohit Ranjan
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Rudra Prasad Ghorai
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Sunil Kumar
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Shivcharan Navriya
- All India Institute of Medical Sciences - Rishikesh, 442339, Rishikesh, Uttarakhand, India;
| | - Àrup Mandal
- All India Institute of Medical Sciences - Rishikesh, 442339, Urology, Rishikesh, Uttarakhand, India;
| |
Collapse
|
|
4
|
Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for renal insufficiency. World J Urol 2021; 39:4477-4482. [PMID: 34076752 DOI: 10.1007/s00345-021-03751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the effect and outcome of percutaneous nephrolithotomy (PNL) versus extracorporeal shock wave lithotripsy (SWL) in patients with renal insufficiency. PATIENTS AND METHODS A prospective randomized clinical study of 104 renal insufficiency patients with renal stones (serum creatinine 2-4 mg/dl and eGFR < 60 ml/min/1.73 m2 more than 3 months) randomized into two groups: Group A underwent PNL; Group B underwent shock wave lithotripsy (SWL). Treatment effects and outcomes compared between the two groups. RESULTS Between Group A of 50 patients and Group B of 54 cases, demographic data showed no statistically significant differences. The stone-free rate was 84% in Group A versus 26.6% in Group B after the first SWL session. After completion of all SWL sessions, the rate was 88.9% for Group B. Comparing pre and postoperative results of Group A, there is significant improvement of serum creatinine concentrations by 9.1% (p = 0.001), significant improvement of creatinine clearance (p = 0.000) and eGFR (p = 0.003). Although regarding Group B preoperatively and 3 months after SWL there is significant improvement by 8.7% (p = 0.0001), which is less than that of Group A, there is also, improvement of eGFR by 6.7% (p = 0.001), which is less than the eGFR improvement in Group A (12.3%). But there is no statistically significant difference is noted for creatinine clearance in Group B (p = 0.09). CONCLUSION The outcomes for PNL and SWL in patients with renal insufficiency and renal stones are encouraging as minimally invasive procedures with no negative effects on kidney function.
Collapse
|
|
5
|
Living Donor Gifted Lithiasis: Long-Term Outcomes in Recipients. Transplant Proc 2021; 53:1091-1094. [PMID: 33608128 DOI: 10.1016/j.transproceed.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Presence of nephrolithiasis in a living donor has been at least a relative contraindication to living donor nephrectomy. The concern for stone recurrence and outcomes has been one of the reasons for reluctance to consider these medically complex donors. We evaluate long-term outcomes in recipients of kidney grafts from donors with nephrolithiasis, or history of nephrolithiasis, and provide results from our experience at Indiana University. MATERIALS AND METHODS We retrospectively reviewed 57 donor-recipient pairs, where the allograft was received from a living donor with symptomatic calculi, or with imaging evidence of kidney stones, between 2003 and 2018. This research study was done in compliance with the ethical standards set forth in the Helsinki Congress. RESULTS The mean age of recipients was 46±19 years and 58% were male. Kidney recipients were followed for a median of 3.5 years and 59.6% of patients had follow-up imaging studies. None of the recipients had obstructing renal calculi or related infections. None of the recipients required any interventions for recurrent calculi and no stone episode lead to adverse event to the graft. Hyperoxaluria and hypercalciuria were the most common risk factors in 24-hour urine collections obtained from donors. CONCLUSIONS Our findings from a single large center looking at kidney recipient outcomes over a long follow-up period found that gifted lithiasis is a safe procedure. Careful selection of "medically complex donors" with kidney stones based on appropriate guidelines is a key step. Further studies are needed to help develop consensus guidelines.
Collapse
|
|
6
|
Izol V, Deger M, Akdogan N, Ok F, Bayazit Y, Aridogan IA. The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease. J Endourol 2020; 35:583-588. [PMID: 33054416 DOI: 10.1089/end.2020.0512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: We evaluated the influence of percutaneous nephrolithotomy (PCNL) on the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Materials and Methods: Between September 2007 and April 2019, 280 patients with a preoperative eGFR level <90 mL/min/1.73 m2 and who underwent PCNL were retrospectively examined. The primary endpoint of this study was the effect of PCNL on eGFR levels in the 1st and 12th month after surgery in patients with CKD according to CKD stages. The secondary endpoint of this study was the identification of potential risk factors for deteriorated eGFRs. Results: The mean eGFR of patients was 48.7 ± 17 mL/min/1.73 m2 in the preoperative period, 54.7 ± 21 mL/min/1.73 m2 in the postoperative 1st month, and 59.1 ± 23.2 mL/min/1.73 m2 in the postoperative 12th month. It was determined that the increases in eGFRs in the postoperative 1st and 12th months were significant in all CKD stages (p < 0.005). Compared with preoperative values, the eGFR value was reduced in 61 (21.8%) patients in the 1st month and 49 (17.5%) patients in the 12th month. When these patients were compared with those in the stable eGFR and recovery group, multiaccess PCNL was an independent risk factor for renal function deterioration at the postoperative 1st and 12th month on multivariate analysis (odds ratios were 6.94 and 9.46, respectively). Conclusion: PCNL was found to have a positive effect on short- and long-term eGFRs in patients with CKD. However, multiaccess PCNL may have adversely affected eGFRs in both the short and long term.
Collapse
Affiliation(s)
- Volkan Izol
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Mutlu Deger
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Nebil Akdogan
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Fesih Ok
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Yildirim Bayazit
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | | |
Collapse
|
|
7
|
Sui W, Calvert JK, Kavoussi NL, Gould ER, Miller NL, Bejan CA, Hsi RS. Association of Chronic Kidney Disease Stage with 24-Hour Urine Values Among Patients with Nephrolithiasis. J Endourol 2020; 34:1263-1271. [PMID: 32578450 DOI: 10.1089/end.2020.0403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Nephrolithiasis is a known risk factor for chronic kidney disease (CKD); however, it is unknown how CKD affects urinary parameters related to stone risk. The purpose of this study was to assess the relationship of diminishing glomerular filtration rate (GFR) and kidney stone-related 24-hour urine (24H urine) composition. Materials and Methods: A single-institution retrospective review of patients (n = 2057) who underwent 24H urine analysis was performed. The serum creatinine within 1 year of the first 24H urine was used to determine estimated GFR and stratify patients by CKD stage. We performed analysis of variance and multivariable linear regression to assess the relationship of GFR and urinary analytes. Results: Among all patients, there were 184 (8.9%), 1537 (74.7%), 245 (11.9%), 70 (3.4%), 17 (0.8%), and 4 (0.2%) in CKD stage I, II, IIIa, IIIb, IV, and V groups, respectively. On analysis of 24H urine composition, as CKD increased, changes in urinary parameters protective against crystallization included decreased calcium and uric acid (UA) (P < 0.001). In addition, parameters favoring crystallization included decreased citrate and magnesium (P = 0.002 and P < 0.001, respectively). The net effect with increasing GFR was decreasing supersaturation of calcium oxalate and phosphate. On linear regression, urinary excretion of calcium, oxalate, citrate, UA, phosphate, and ammonia all decreased with decreasing GFR (all P < 0.05). Conclusions: Higher CKD stage was associated with changes in urinary analytes that both promoted and inhibited stone formation, with the net effect of decreasing calcium oxalate and phosphate supersaturation. These patients may benefit from medical therapy that targets improving urinary citrate instead of lowering calcium or UA.
Collapse
Affiliation(s)
- Wilson Sui
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Josh K Calvert
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas L Kavoussi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edward R Gould
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole L Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cosmin A Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
|
8
|
Patel PM, Kandabarow AM, Druck A, Hart S, Blackwell RH, Kadlec A, Farooq A, Turk TMT, Baldea KG. Association of Impaired Renal Function With Changes in Urinary Mineral Excretion and Stone Composition. Urology 2020; 141:45-49. [PMID: 32294484 DOI: 10.1016/j.urology.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of kidney function on stone composition and urinary mineral excretion in patients undergoing surgical intervention for nephrolithiasis. METHODS Using our institutional kidney stone database, we performed a retrospective review of stone patients who underwent surgical intervention between 2004 and 2015. Patients' demographic information, 24-hour urinary mineral excretion, and stone characteristics were reported. The patients' estimated glomerular filtration rates (eGFR) were compared with their stone compositions and 24-hour urine mineral excretions. RESULTS A statistically significant difference was noted between the groups, with uric acid stones being associated with lower eGFR and calcium phosphate stones associated with higher eGFR. No relationship could be demonstrated between eGFR and calcium oxalate or struvite stones. Patients with lower eGFR also demonstrated a statistically significant association with lower urinary pH as well as lower urinary excretion of calcium and citrate. CONCLUSION While various factors have been found to play significant roles in kidney stone formation and composition, our findings demonstrate a definite relationship between these and renal function. This paper highlights the fact that renal function evaluation should be considered an important component in the evaluation, counseling, and management of patients with nephrolithiasis.
Collapse
Affiliation(s)
- Parth M Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL.
| | | | - Aleksander Druck
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL
| | - Spencer Hart
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | | | - Ahmer Farooq
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Kristin G Baldea
- Department of Urology, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
|
9
|
Patel R, Agarwal S, Sankhwar SN, Goel A, Singh BP, Kumar M. A prospective study assessing feasibility of performing percutaneous nephrolithotomy in chronic kidney disease patients - What factors affect the outcome? Int Braz J Urol 2019; 45:765-774. [PMID: 31136109 PMCID: PMC6837603 DOI: 10.1590/s1677-5538.ibju.2018.0816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/24/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. Materials and Methods Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0–2] were included in the study. Results A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not significant enough to cause stage migration. Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not significant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the final follow up visit (6 months). Conclusion Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.
Collapse
Affiliation(s)
- Rohan Patel
- Department of Urology, King George's Medical University, Lucknow, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - S N Sankhwar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
| | - B P Singh
- Department of Urology, King George's Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| |
Collapse
|
|
10
|
Jones P, Aboumarzouk OM, Zelhof B, Mokete M, Rai BP, Somani BK. Percutaneous Nephrolithotomy in Patients With Chronic Kidney Disease: Efficacy and Safety. Urology 2017; 108:1-6. [DOI: 10.1016/j.urology.2017.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
|
|
11
|
Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Jaffer Sathick IJ, Dhondup T, Erickson SB. Incidence of kidney stones in kidney transplant recipients: A systematic review and meta-analysis. World J Transplant 2016; 6:790-797. [PMID: 28058231 PMCID: PMC5175239 DOI: 10.5500/wjt.v6.i4.790] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the incidence and characteristics of kidney stones in kidney transplant recipients.
METHODS A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the inception of the databases through March 2016. Studies assessing the incidence of kidney stones in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of kidney stones.
RESULTS Twenty one studies with 64416 kidney transplant patients were included in the analyses to assess the incidence of kidney stones after kidney transplantation. The estimated incidence of kidney stones was 1.0% (95%CI: 0.6%-1.4%). The mean duration to diagnosis of kidney stones after kidney transplantation was 28 ± 22 mo. The mean age of patients with kidney stones was 42 ± 7 years. Within reported studies, approximately 50% of kidney transplant recipients with kidney stones were males. 67% of kidney stones were calcium-based stones (30% mixed CaOx/CaP, 27%CaOx and 10%CaP), followed by struvite stones (20%) and uric acid stones (13%).
CONCLUSION The estimated incidence of kidney stones in patients after kidney transplantation is 1.0%. Although calcium based stones are the most common kidney stones after transplantation, struvite stones (also known as “infection stones”) are not uncommon in kidney transplant recipients. These findings may impact the prevention and clinical management of kidney stones after kidney transplantation.
Collapse
|
|
12
|
Nephrolithiasis as a risk factor of chronic kidney disease: a meta-analysis of cohort studies with 4,770,691 participants. Urolithiasis 2016; 45:441-448. [DOI: 10.1007/s00240-016-0938-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/04/2016] [Indexed: 01/12/2023]
|
|
13
|
Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, Kim WJ. Effect of renal insufficiency on stone recurrence in patients with urolithiasis. J Korean Med Sci 2014; 29:1132-7. [PMID: 25120325 PMCID: PMC4129207 DOI: 10.3346/jkms.2014.29.8.1132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/07/2014] [Indexed: 11/20/2022] Open
Abstract
The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance ≤60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.
Collapse
Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sung Phil Seo
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
|
14
|
Kawada N, Isaka Y, Rakugi H, Moriyama T. SCAD syndrome: A vicious cycle of kidney stones, CKD, and AciDosis. World J Clin Urol 2014; 3:113-118. [DOI: 10.5410/wjcu.v3.i2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 05/23/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Cumulative evidence has shown that kidney stone formers are at high risk for developing end-stage renal disease (ESRD) and cardiovascular disease. The aim of this mini-review is to summarize the present knowledge about the close relationships among kidney stone formation, chronic kidney disease (CKD), and plasma and urine acidosis (SCAD). Part of the cause of the positive relationships between higher risk of developing ESRD and cardiovascular diseases in stone formers may be explained by inflammation and cell death due to the components of kidney stones. In CKD patients, acidic urine and loss of anti-crystallization factors may cause stone formation. Acidosis can promote tissue inflammation and may affect vascular tone. Correction of plasma and urine acidosis may improve renal and cardiovascular outcome of stone formers and CKD patients. More intensive and long-term interventions, which include correction of plasma and urine pH in patients with reduced renal function and correction of urine pH in patients with normal renal function, may be considered in treating patients with SCAD syndrome.
Collapse
|
|
15
|
Mishra S, Sinha L, Ganesamoni R, Ganpule A, Sabnis RB, Desai M. Renal deterioration index: preoperative prognostic model for renal functional outcome after treatment of bilateral obstructive urolithiasis in patients with chronic kidney disease. J Endourol 2013; 27:1405-10. [PMID: 23537205 DOI: 10.1089/end.2012.0456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients who present with varying severity of obstructive urolithiasis behave differently after the treatment. Some patients recover with improved renal function while others progress to renal failure. Our objective was to objectively quantify which patients would progress to renal failure after treatment for obstructive urolithiasis. PATIENTS AND METHODS A prospective analysis of 167 patients with renal failure from bilateral obstructive urolithiasis who were treated and subsequently followed for at least 1 year was performed. Failure was defined as glomerular filtration rate (GFR) values less than 15 mL/min at 1 year follow-up. All patients had preoperative placement of a percutaneous nephrostomy tube for at least 5 days before treatment with either ureteroscopy or percutaneous nephrolithotomy. Multiple logistic regression analysis of affecting parameters was performed. A renal deterioration index (RDI) was constructed based on scores assigned to varying severity of multivariate significant factors and the receiver operating characteristic (ROC) curve was analyzed. RESULTS There were 48(28.7%) patients who progressed to CKD stage V at 1-year follow-up. Combined cortical width (≤ 0.001), proteinuria (0.01), positive urine culture (0.004), and nadir preoperative GFR postbilateral percutaneous nephrostomy (0.016) were statistically significant factors affecting renal deterioration on multivariate analysis. RDI has a high ROC curve (AUC=0.90) for predicting renal functional outcome. Combining these parameters in a prediction table yielded a RDI score ≥ 12 being associated with high odds risk (odds ratio=11.2) of treatment failure. CONCLUSION RDI ≥ 12 is associated with renal deterioration after appropriate treatment of bilateral obstructive urolithiasis.
Collapse
Affiliation(s)
- Shashikant Mishra
- Department of Urology, Muljibhai Patel Urological Hospital , Nadiad, Gujarat, India
| | | | | | | | | | | |
Collapse
|
|
16
|
Kartha G, Calle JC, Marchini GS, Monga M. Impact of stone disease: chronic kidney disease and quality of life. Urol Clin North Am 2012. [PMID: 23177641 DOI: 10.1016/j.ucl.2012.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article reviews the impact of stone disease on chronic kidney disease and renal function; evaluating the natural progression of disease as well as the impact of surgical interventions. The impact of stone disease, medical therapy, and surgical therapy for stones on quality of life is discussed.
Collapse
Affiliation(s)
- Ganesh Kartha
- Department of Urology, Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH 44120, USA
| | | | | | | |
Collapse
|
|
17
|
Ozden E, Bostanci Y, Sarikaya S. Reply by the Authors. Urology 2012. [DOI: 10.1016/j.urology.2012.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
|
18
|
Sairam K, Scoffone CM, Alken P, Turna B, Sodha HS, Rioja J, Wolf JS, de la Rosette JJMCH. Percutaneous nephrolithotomy and chronic kidney disease: results from the CROES PCNL Global Study. J Urol 2012; 188:1195-200. [PMID: 22901573 DOI: 10.1016/j.juro.2012.06.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We compared the characteristics and outcomes of patients treated with percutaneous nephrolithotomy in the CROES (Clinical Research Office of the Endourological Society) Global Study according to preoperative renal function. MATERIALS AND METHODS Prospective data on consecutive patients treated with percutaneous nephrolithotomy in a 1-year period were collected from 96 participating centers. The glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula based on preoperative serum creatinine measurement. Patients were divided into 3 groups by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS Estimated glomerular filtration rate data were available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse postoperative outcomes than those in the other chronic kidney disease groups. CONCLUSIONS Poor renal function negatively impacts the post-percutaneous nephrolithotomy outcome. By more aggressive removal of kidney stones, particularly staghorn stones, at first presentation and more vigilantly attempting to prevent recurrence through infection control, pharmacological or other interventions, the progression of chronic kidney disease due to nephrolithiasis may be mitigated.
Collapse
Affiliation(s)
- Krish Sairam
- Department of Urology, Global Hospitals and Health City, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | | | | |
Collapse
|
|
19
|
Ozden E, Mercimek MN, Bostanci Y, Yakupoglu YK, Sirtbas A, Sarikaya S. Long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease: a single-center experience. Urology 2012; 79:990-4. [PMID: 22309786 DOI: 10.1016/j.urology.2011.10.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 09/22/2011] [Accepted: 10/21/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To present our long-term follow-up data from patients with kidney stones and chronic kidney disease to identify the factors that could help predict the likelihood of long-term deterioration in renal function. METHODS From January 2002 to July 2010, we performed 1117 percutaneous nephrolithotomy (PNL) procedures in 1051 patients. We retrospectively analyzed 69 PNL procedures for 67 patients (47 men and 20 women) in whom the estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m(2). Two outcomes were measured. The percentage of change in the eGFR was measured comparing the preoperative and postoperative values. A 5% change in renal function was arbitrarily chosen to divide the population into 3 groups: group 1, an eGFR change of ≤ 5%; group 2, an eGFR increase of >5%; and group 3, an eGFR decrease of <5%. The second outcome measure was the presence of chronic kidney disease progressing in the first and consecutive years. RESULTS The mean patient age was 57 ± 14.1 years. The complication rate was 23.1% using the Clavien classification. The mean follow-up time was 45.7 ± 17.08 months. The mean eGFR before and after PNL was 37.9 ± 14.05 and 45.1 ± 16.8, respectively. Diabetes mellitus (odds ratio 15.82, P = .036) and urinary infection (odds ratio 10.6, P = .04) were predictive of renal function deterioration at 1 year on multivariate analysis. CONCLUSION PNL in patients with chronic kidney disease is safe and results in renal function preservation for a 5-year period. Diabetes mellitus and urinary infection were independent predictive of renal function impairment. Therefore, patients with diabetes mellitus and urinary tract infection should be followed up carefully and informed about hazardous potential of those diseases.
Collapse
Affiliation(s)
- Ender Ozden
- Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | | | | | | | | | | |
Collapse
|
|
20
|
Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol 2011; 187:173-7. [PMID: 22099999 DOI: 10.1016/j.juro.2011.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluated the long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease. MATERIALS AND METHODS Data on 1,904 patients who underwent percutaneous nephrolithotomy between 2002 and 2011 were retrospectively collected. The estimated glomerular filtration rate for each patient was retrospectively calculated using a 4-variable modification of diet in renal disease equation. Patients were staged for chronic kidney disease by National Kidney Foundation guidelines. RESULTS A total of 242 patients (12.7%) had a preoperative glomerular filtration rate of less than 60 ml per minute/1.73 m(2). Those monitored a minimum of 1 year were included in analysis. The study included 177 patients with a mean ± SD age of 54.3 ± 12.1 years. Perioperative and postoperative complications were noted in 15.2% of patients. At a mean followup of 43.4 ± 22.7 months renal function in 29.4% of patients had improved but it remained the same or deteriorated in 54.2% and 16.4%, respectively. On multivariate regression analysis diabetes and preoperative or postoperative complications predicted renal function. The stone-free rate 3 months postoperatively was 80.2% (142 of 177 cases). Stones recurred during long-term followup in 36 of these patients (25.3%). Spontaneous stone passage was detected in 12 of the 35 patients (34.2%) with residual stones but 8 (22.8%) with residual stones experienced an increase in stone size. CONCLUSIONS At long-term followup renal function was maintained or improved in greater than 80% of patients with chronic kidney disease who underwent percutaneous nephrolithotomy. Stones recurred or residual stones grew in approximately 25% of these patients.
Collapse
|
|
21
|
Bucuras V, Gopalakrishnam G, Wolf JS, Sun Y, Bianchi G, Erdogru T, de la Rosette J. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol 2011; 26:336-41. [PMID: 22004844 DOI: 10.1089/end.2011.0169] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE The study compared characteristics and outcomes in patients with solitary and bilateral kidneys who were treated with percutaneous nephrolithotomy (PCNL) in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. PATIENTS AND METHODS Data from consecutively treated patients from 96 centers worldwide were collated after a 1-year period. The following variables in patients undergoing PCNL with solitary or bilateral kidneys were compared: Prevalence, patient characteristics, intraoperative differences and outcomes, including bleeding and transfusion rates, renal function, and stone-free rates. RESULTS Data from 5803 patients were collated; 189 (3.3%) with solitary and 5556 (96.7%) with bilateral kidneys. Patient characteristics were well matched generally with the exception of cardiovascular disease and American Society of Anesthesiologists (ASA) risk scores, which were significantly greater in patients with solitary than with bilateral kidneys (P<0.0001 and P=0.004, respectively). Patients with solitary kidneys had also undergone significantly more procedures to remove calculi before this survey than bilateral patients (P= 00.049 -<0.0001). Levels of renal impairment were significantly greater (P<0.0001) and stone-free rates were significantly lower (P=0.001) post-PCNL in solitary than bilateral kidney patients. Although bleeding rates were the same in both groups, transfusion rates were significantly greater in solitary kidney patients (P=0.014). CONCLUSIONS Patients with a solitary kidney had a higher cardiovascular risk and ASA score. Outcomes related to morbidity and stone-free rate were less favorable for solitary kidneys.
Collapse
Affiliation(s)
- Viorel Bucuras
- Department of Urology, Timisoara Clinical Emergency Hospital, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Kadlec AO, Greco KA, Fridirici ZC, Gerber D, Turk TM. Effect of Renal Function on Urinary Mineral Excretion and Stone Composition. Urology 2011; 78:744-7. [DOI: 10.1016/j.urology.2011.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/04/2011] [Accepted: 04/04/2011] [Indexed: 10/18/2022]
|
|
23
|
Rule AD, Krambeck AE, Lieske JC. Chronic kidney disease in kidney stone formers. Clin J Am Soc Nephrol 2011; 6:2069-75. [PMID: 21784825 DOI: 10.2215/cjn.10651110] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Recent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed.
Collapse
Affiliation(s)
- Andrew D Rule
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
|
24
|
|
|
25
|
Kuzgunbay B, Gul U, Turunc T, Egilmez T, Ozkardes H, Yaycioglu O. Long-term renal function and stone recurrence after percutaneous nephrolithotomy in patients with renal insufficiency. J Endourol 2010; 24:305-8. [PMID: 20039820 DOI: 10.1089/end.2009.0362] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We analyzed long-term results after percutaneous nephrolithotomy (PCNL) in patients with impaired renal function. PATIENTS AND METHODS Nineteen (6.3%) of 300 patients who underwent PCNL had serum creatinine values above 1.4 mg/dL before surgery and were considered to have impaired renal function. Success rate of operation, recurrence rate, and renal functional status were evaluated. RESULTS Mean follow-up time was 51.1 +/- 10.1 months. Sixteen patients completed the study, but three patients were lost to follow-up. The results of the operation were as follows: stone free in 50%, clinically insignificant residual fragments in 25%, and clinically significant residual fragments in 25% of the patients. Mean serum creatinine value was 2.30 +/- 0.56 mg/dL before surgery and 2.67 +/- 1.41 mg/dL at the end of follow-up (p = 0.386). Creatinine values decreased to normal range in six patients (37.5%). Six patients (37.5%) had stable renal function (creatinine: 1.4-4 mg/dL). Creatinine values increased (>4 mg/dL) in four patients (25%) who required renal replacement therapy. Three new patients progressed to end-stage renal failure. These three had insulin-dependent type II diabetes mellitus and one also had solitary kidney and atherosclerosis. Two patients (12.5%) had recurrences, one of these had hypercalciuria, and the other had infection stone. CONCLUSION Our results indicated that most patients presenting with kidney-stone disease and renal insufficiency experience improvement or stabilization of renal function after PCNL. The patients with solitary kidney and those with conditions such as diabetes and atherosclerosis might be at greater risk for deterioration of renal function. Patients with metabolic abnormalities and infection stones might be at higher risk for recurrence.
Collapse
Affiliation(s)
- Baris Kuzgunbay
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
|
26
|
Kurien A, Baishya R, Mishra S, Ganpule A, Muthu V, Sabnis R, Desai M. The impact of percutaneous nephrolithotomy in patients with chronic kidney disease. J Endourol 2009; 23:1403-7. [PMID: 19694531 DOI: 10.1089/end.2009.0339] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The impact of percutaneous nephrolithotomy (PCNL) in chronic kidney disease (CKD) patients was retrospectively analyzed in this study. We analyzed the factors that can impair renal function and predict the need for renal replacement therapy (RRT) after PCNL. PATIENTS AND METHODS Ninety-one chronic kidney patients with a mean age of 52.5 +/- 13 involving 117 renal units underwent PCNL in our institution for 5 years. A mean of 1.6 +/- 1.1 tracks and 1.3 +/- 0.6 sittings per renal unit was required for PCNL. The estimated glomerular filtration rate (eGFR) pre-PCNL (postdrainage), peak eGFR on follow-up, and eGFR at last follow-up were recorded. The CKD stage pre-PCNL was compared with the CKD stage at last follow-up. RESULTS Complete clearance, auxiliary procedure, and complication rates were 83.7%, 2.5%, and 17.1%, respectively. The mean eGFR pre-PCNL and peak eGFR at follow-up were 32.1 +/- 12.8 and 43.3 +/- 18.8 mL/minute/1.73 m(2), respectively (p < 0.0001). At a mean follow-up of 329 +/- 540 days, deterioration with up-migration of CKD stage was seen in 12 patients (13.2%). Eight patients (8.8%) required RRT in the form of either maintenance hemodialysis or renal transplantation. Postoperative bleeding complication requiring blood transfusions was seen in seven (5.9%) and two (1.7%) of the renal units subsequently required super selective angioembolization. There were two mortalities in the postoperative period. Postoperative complications and peak eGFR (less than 30 mL/minute/1.73 m(2)) at follow-up are two factors that predict renal deterioration and RRT. Renal parenchymal thickness (<8 mm) also predicts the need for RRT. CONCLUSION PCNL has a favorable impact in CKD patients with good clearance rates and good renal functional outcome. PCNL in this high-risk CKD population is to be done with care and full understanding of its complications.
Collapse
Affiliation(s)
- Abraham Kurien
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | | | | | | | | | | | | |
Collapse
|
|
27
|
Saucier NA, Sinha MK, Liang KV, Krambeck AE, Weaver AL, Bergstralh EJ, Li X, Rule AD, Lieske JC. Risk factors for CKD in persons with kidney stones: a case-control study in Olmsted County, Minnesota. Am J Kidney Dis 2009; 55:61-8. [PMID: 19853335 DOI: 10.1053/j.ajkd.2009.08.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/13/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Kidney stones are associated with increased risk of chronic kidney disease (CKD); however, risk factors in the general community are poorly defined. STUDY DESIGN A nested case-control study was performed in residents of Olmsted County, MN, who presented with a kidney stone at the Mayo Clinic in 1980-1994 to contrast patients with kidney stones who developed CKD with a group that did not. SETTING & PARTICIPANTS Participants were selected from the Rochester Epidemiology Project, an electronic linkage system among health care providers in Olmsted County, MN. Cases were identified by diagnostic code for CKD and confirmed to have an estimated glomerular filtration rate < 60 mL/min/1.73 m(2). Controls were matched 2:1 to cases for age, sex, date of first kidney stone, and length of medical record. PREDICTOR Charts were abstracted to characterize stone disease, hypertension, diabetes, obesity, tobacco use, ileal conduit, symptomatic stones, type and number of stones, urinary tract infections, number and type of surgical procedures, and medical therapy. OUTCOMES & MEASUREMENTS Kidney stone patients with CKD were compared with matched stone patients without CKD. RESULTS There were 53 cases and 106 controls with a mean age of 57 years at first stone event and 59% men. In kidney stone patients, cases with CKD were significantly more likely (P < 0.05) than controls to have had a history of diabetes (41.5% vs 17.0%), hypertension (71.7% vs 49.1%), frequent urinary tract infections (22.6% vs 6.6%), struvite stones (7.5% vs 0%), and allopurinol use (32.1% vs 4.7%) based on univariate analysis. LIMITATIONS Potential limitations include limited statistical power to detect associations, incomplete data from 24-hour urine studies, and that stone composition was not always available. CONCLUSION As in the general population, hypertension and diabetes are associated with increased risk of CKD in patients with kidney stones. However, other unique predictors were identified in patients with kidney stones that increased the possibility of CKD. Further studies are warranted to elucidate the nature of these associations.
Collapse
Affiliation(s)
- Nathan A Saucier
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Rule AD, Bergstralh EJ, Melton LJ, Li X, Weaver AL, Lieske JC. Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 2009; 4:804-11. [PMID: 19339425 DOI: 10.2215/cjn.05811108] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney stones lead to chronic kidney disease (CKD) in people with rare hereditary disorders (e.g., primary hyperoxaluria, cystinuria), but it is unknown whether kidney stones are an important risk factor for CKD in the general population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among Olmsted County, MN, residents, all stone formers (n = 4774) whose condition was diagnosed in 1986 through 2003 were matched 1:3 to control subjects (n = 12,975). Cox proportional hazards models adjusted for age, gender, and comorbidities (hypertension, diabetes, obesity, dyslipidemia, gout, alcohol abuse, tobacco use, coronary artery disease, heart failure, cerebral infarct, and peripheral vascular disease) were used to assess the risk for incident CKD defined as a clinical diagnosis (diagnostic codes), ESRD or death with CKD, sustained (>90 d) elevated serum creatinine (>1.3 mg/dl in men, >1.1 mg/dl in women), or sustained estimated GFR <60 ml/min per 1.73 m(2). RESULTS During a mean of 8.6 yr of follow-up, stone formers were at increased risk for a clinical diagnosis of CKD, but an increased risk for ESRD or death with CKD was NS. Among patients with follow-up serum creatinine levels, stone formers were at increased risk for a sustained elevated serum creatinine and a sustained reduced GFR. CONCLUSIONS Kidney stones are a risk factor for CKD, and studies are warranted to assess screening and preventive measures for CKD in stone formers.
Collapse
Affiliation(s)
- Andrew D Rule
- Departments of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota 55905.
| | | | | | | | | | | |
Collapse
|
|
29
|
Bilen CY, Inci K, Kocak B, Tan B, Sarikaya S, Sahin A. Impact of percutaneous nephrolithotomy on estimated glomerular filtration rate in patients with chronic kidney disease. J Endourol 2008; 22:895-900. [PMID: 18393644 DOI: 10.1089/end.2007.0435] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE We investigated the impact of percutaneous renal procedures on estimated glomerular filtration rate (GFR) of patients with chronic kidney disease (CKD). PATIENTS AND METHODS The GFRs of adult patients were calculated using the Modification of Diet in Renal Disease formula, and the patients were staged according to the Kidney Disease Outcome Quality Initiative CKD classification system. The study included 185 patients with preoperative GFR values less than 60 mL/min/1.73 m(2). The impact of percutaneous nephrolithotomy (PCNL) on GFR was analyzed by comparing the preoperative GFR with the GFR before discharge and at postoperative month 3. RESULTS Patients with CKD had a significant increase in the GFR after the procedure. In postoperative month 3, the mean GFR was more than 60 mL/min/1.73 m(2) in 25% of the patients with CKD and less than 60 mL/min/1.73 m(2) in 75%. While all patients with stage 5 CKD improved to better stages, some other patients' conditions declined to stage 5 from better stages at the end of postoperative month 3. No patient needed dialysis. The presence of urinary tract infections tended to affect GFR negatively. CONCLUSION Estimated GFR, as a better indicator of renal function, is significantly affected by the PCNL procedure. While significant improvement was observed in late-stage patients with CKD, unexpected deterioration could occur in patients at earlier stages.
Collapse
Affiliation(s)
- Cenk Y Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
|
30
|
Yaycioglu O, Egilmez T, Gul U, Turunc T, Ozkardes H. Percutaneous nephrolithotomy in patients with normal versus impaired renal function. ACTA ACUST UNITED AC 2007; 35:101-5. [PMID: 17287962 DOI: 10.1007/s00240-007-0081-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 01/18/2007] [Indexed: 10/23/2022]
Abstract
This study aimed to compare the results of percutaneous nephrolithotomy (PCNL) in patients with impaired renal function (IRF) and normal renal function (NRF). Records of 300 consecutive patients who underwent PCNL from July 2002 to July 2005 were retrospectively reviewed. Nineteen patients (6.3%) had serum creatinine values higher than 1.5 mg/dl before surgery (IRF Group). Nineteen gender and age matched patients with normal renal function were chosen as controls (NRF Group). The surgical parameters, outcome, and complication rates were compared. The effect of PCNL on the renal function was assessed in patients with IRF. There were 13 male and 6 female patients in both groups. In the IRF group, seven patients had a solitary kidney and three had bilateral stones. Thus, PCNL was performed on 22 kidneys. No patients in the NRF Group had solitary kidney or bilateral stones and PCNL was performed on 19 kidneys. There were no statistically significant differences between the two groups for success and complication rates (P = 0.376 and P = 0.184, respectively). In a mean follow-up of 15.6 months, mean serum creatinine decreased from 2.8 to 2.6 mg/dl (P = 0.273) in patients of the IRF group. Similar stone clearance and complication rates were obtained with PCNL in patients with impaired and normal renal function. Surgery does not cause biochemical deterioration in patients with compromised renal function before treatment.
Collapse
Affiliation(s)
- Ozgur Yaycioglu
- Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
|
31
|
Jungers P, Joly D, Barbey F, Choukroun G, Daudon M. Insuffisance rénale terminale d'origine lithiasique : fréquence, causes et prévention. Nephrol Ther 2005; 1:301-10. [PMID: 16895699 DOI: 10.1016/j.nephro.2005.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 04/20/2005] [Accepted: 08/12/2005] [Indexed: 11/26/2022]
Abstract
Nephrolithiasis still remains a too frequent - and under-appreciated - cause of end-stage renal disease (ESRD), and this is all the most unfortunate since such an untoward course is now preventable in most cases. Among 1391 patients who started maintenance dialysis at Necker hospital between 1989 and 2000, nephrolithiasis was identified as the cause of ESRD in 45 of them, an overall prevalence of 3.2%. Infection stones accounted for 42.2% of cases, calcium stones for 26.7%, uric acid stones for 17.8% and hereditary diseases for 13.3%. The proportion of nephrolithiasis-associated ESRD declined from 4.7% to 2.2% from the 1989-1991 to the 1998-2000 period, as a result of the decreased incidence of ESRD in patients with infection and calcium nephrolithiasis. Based on our observations and on published reports, it emerges that most cases of nephrolithiasis-associated ESRD were due to sub-optimal management (especially in the case of infection or cystine stones) or to late (or erroneous) etiologic diagnosis, precluding early institution of appropriate therapeutic measures. In particular, several patients with primary hyperoxaluria or 2,8-dihydroxyadeninuria were diagnosed while already on dialysis or after unsuccessful kidney transplantation, due to wrong initial diagnosis. In conclusion, thanks to recent advances in diagnosis and management of stone formers, ESRD should now be prevented in the great majority of patients, at the condition of early etiologic diagnosis based on accurate morphoconstitutional analysis of calculi and metabolic evaluation, and early implementation of appropriate preventive medical treatment.
Collapse
Affiliation(s)
- Paul Jungers
- Hôpital Necker, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | | | | | | | | |
Collapse
|
|
32
|
Kukreja R, Desai M, Patel SH, Desai MR. Nephrolithiasis associated with renal insufficiency: factors predicting outcome. J Endourol 2004; 17:875-9. [PMID: 14744353 DOI: 10.1089/089277903772036181] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Renal calculous disease may be associated with various degrees of renal insufficiency secondary to a combination of obstruction, urinary infection, frequent surgical intervention, and coexisting medical disease. Herein, we present our data on the progression of renal function in patients with stones associated with renal insufficiency and assess the significance of various factors that could predict postoperative renal function deterioration. PATIENTS AND METHODS Data were obtained from 4400 patients undergoing treatment for calculous disease at our institute since 1991. Renal insufficiency, defined as a baseline serum creatinine >1.5 mg/dL, was present in 84 (1.9%). Predictive factors evaluated for renal function deterioration were preoperative (age, duration of symptomatology and nephrolithiasis, urinary tract infection, coexistent medical diseases, baseline serum creatinine, and stone burden), intraoperative (number of percutaneous tracts), and postoperative (recurrent infection, proteinuria, cortical atrophy, residual fragments, and stone recurrence). RESULTS Over a mean follow-up of 2.2 years (range 6 months-6 years), 33 patients (39.3%) showed improvement, 24 (28.6%) showed stabilization, and 27 (32.1%) showed deterioration in their renal function. Higher baseline serum creatinine, proteinuria >300 mg/day, renal cortical atrophy, stone burden >1500 mm(2), recurrent urinary infection, and age <15 years were significant predictors of subsequent renal function deterioration. CONCLUSIONS Patients with nephrolithiasis and mild to moderate renal insufficiency warrant aggressive treatment aimed at complete stone clearance and prevention of recurrence of stones and urinary infection. A higher baseline preoperative serum creatinine, proteinuria >300 mg/day on follow-up, renal cortical atrophy, stone burden >1500 mm(2), recurrent urinary infection, and age <15 years are associated with a significantly higher likelihood of renal function deterioration after treatment of the calculous disease.
Collapse
Affiliation(s)
- Rajesh Kukreja
- Department of Urology, Muljibhai Patel Urological Hospital, Dr. V.V. Desai Road, Nadiad, Gujarat 387001, India
| | | | | | | |
Collapse
|
|
33
|
Singh I, Gupta NP, Hemal AK, Aron M, Dogra PN, Seth A. Efficacy and outcome of surgical intervention in patients with nephrolithiasis and chronic renal failure. Int Urol Nephrol 2002; 33:293-8. [PMID: 12092642 DOI: 10.1023/a:1015230510071] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM To prospectively evaluate the efficacy and outcome of surgical intervention in patients with renal stones and chronic renal insufficiency. METHODS The study was carried out from January 1999 till January 2001. Only patients with chronic renal failure without medical renal disease were taken up for study. All patients were subjected to an ultrasound assessment of the kidney, ureter and bladder. In case of obstructed and infected systems a preliminary percutaneous nephrostomy was carried out. After correction of dyselectrolytemia, acid base imbalance and dialysis (if indicated) patients were subjected to surgical intervention (open surgery or percutaneous nephrolithotomy). ESWL was offered for stones persisting after surgery. The stone burden, composition, therapeutic procedures required to render patients stone free were assessed. The outcome of stone removal on renal function was also evaluated by serial renal dynamic scans and creatinine clearance estimations. RESULTS Out of 90 patients operated for staghorn or calyceal calculi, complete follow up data was available in 70. Pyelo-nephrolithotomy and percutaneous nephrolithotomy was carried out in 63 and 7 patients respectively. Out of 15 patients with residual stones ESWL was successfully performed in 9 cases. Mixed, calcium oxalate monohydrate, calcium oxalate dihydrate, and struvite stones were encountered in 48%, 14%, 17% and 21% respectively. The average pre operative serum creatinine was 4.76 (1.9-16) mg%. The maximum duration of follow up was 9 months. By the 9th post operative month the average fall in serum creatinine values was 1.53 mg/dl (32%) and the average functional improvement by renal dynamic scans stood at 20.665%. 41 patients were saved from further dialysis. CONCLUSION Patients with mild to moderate renal failure showed maximal improvement in renal function forestalling or reducing the need for dialysis/renal replacement therapy.
Collapse
Affiliation(s)
- I Singh
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
| | | | | | | | | | | |
Collapse
|
|
34
|
Paryani JP, Ather MH. Improvement in serum creatinine following definite treatment of urolithiasis in patients with concurrent renal insufficiency. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2002; 36:134-6. [PMID: 12028687 DOI: 10.1080/003655902753679436] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess whether definitive treatment of urolithiasis following relief of obstruction in patients with renal insufficiency results in further improvement in renal function as determined by serum creatinine. METHODS In a review of 500 patients with urolithiasis, we identified 43 (12%) patients with serum creatinine level of > or =176 micromol/l at the time of presentation. Location and complexity of calculi, type of procedure required to render the patients stone free and effects of surgical intervention (following relief of obstruction) on renal function were evaluated. RESULTS Mean serum creatinine at presentation was 555 micromol/l and after relief of obstruction was 361 micromol/l. Mean serum creatinine level after surgical intervention dropped to 193 micromol/l (p < 0.001). Complete or partial staghorn calculi were seen in 40% of patients. Two-thirds of patients required more than one procedure for complete stone clearance. CONCLUSIONS Renal calculi and concurrent mild to moderate renal insufficiency warrants aggressive treatments. Patients demonstrate significant improvement in renal function independent of relief of obstruction.
Collapse
Affiliation(s)
- J P Paryani
- Section of Urology, Department of Surgery, The Aga Khan University, Stadium Road, Karachi, Pakistan
| | | |
Collapse
|
|
35
|
Grampsas SA, Chandhoke PS, Fan J, Glass MA, Townsend R, Johnson AM, Gabow P. Anatomic and metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease. Am J Kidney Dis 2000; 36:53-7. [PMID: 10873872 DOI: 10.1053/ajkd.2000.8266] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The prevalence of nephrolithiasis is considerably greater in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. We evaluated anatomic and metabolic factors that may be associated with an increased prevalence of nephrolithiasis in patients with ADPKD. We compared anatomic parameters among ADPKD patients with or without nephrolithiasis as diagnosed by ultrasonography, whereas metabolic factors were determined by 24-hour urinary chemical analysis. Patients with ADPKD and nephrolithiasis had more renal cysts (P < 0.05) and a larger predominant renal cyst size (P < 0.005) than patients without nephrolithiasis. Concurrently, individual stone-forming kidneys had a greater cyst number (P < 0.05) and a significantly larger predominant cyst size (P < 0.01) compared with kidneys without stones. Patients with ADPKD and nephrolithiasis had a significantly lower creatinine clearance than those without nephrolithiasis (68.7 +/- 8.6 versus 94.8 +/- 5.4 mL/min, respectively; P < 0.05). Twenty-four-hour urinary analysis showed that patients with ADPKD and nephrolithiasis had significantly lower urinary volumes (P < 0. 05), and levels of urinary phosphate (P < 0.05), magnesium (P < 0. 005), and potassium (P < 0.05). Although not statistically significant, patients with ADPKD with stones tended to have lower levels of urinary citrate, and both groups showed a high percentage (range, 49% to 60%) of patients with hypocitraturia. Our data are consistent with the hypothesis that patients with ADPKD who develop nephrolithiasis do so because of increased intrarenal anatomic obstruction, as well as lower levels of such urinary inhibitors of stones as magnesium and citrate.
Collapse
Affiliation(s)
- S A Grampsas
- Departments of Surgery (Urology), Medicine (Renal Diseases)/Denver Health, and Radiology, University of Colorado Health Sciences Center, Denver, CO, USA
| | | | | | | | | | | | | |
Collapse
|
|
36
|
Agrawal MS, Aron M, Asopa HS. Endourological renal salvage in patients with calculus nephropathy and advanced uraemia. BJU Int 1999; 84:252-6. [PMID: 10468716 DOI: 10.1046/j.1464-410x.1999.00159.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To document our experience with percutaneous nephrolithotripsy (PCNL) for the treatment of calculus nephropathy and advanced renal failure. PATIENTS AND METHODS Between October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16-67; mean serum creatinine level 663.8 micromol/L, range 282.8-1449.7) were treated in our department. Forty-six of the patients had bilateral upper urinary calculi, while the remaining 32 had a solitary functioning kidney obstructed by stone. Thirty-two patients had a normal urine output, 26 were oliguric and 20 presented with anuria. A preliminary percutaneous nephrostomy (PCN) was performed under local anaesthesia in 64 patients, and stone retrieved subsequently through the same nephrostomy track after improvement in their uraemic status. In the remaining 14 patients, the stones were removed at the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2-3 weeks, while 25 patients underwent simultaneous JJ stenting on the contralateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side. RESULTS There were three deaths, caused by overwhelming sepsis; 64 of the remaining 75 patients recovered well from uraemia, while 11 showed no improvement, suggesting irreversible renal damage. Complications included five patients with nonfatal sepsis and five with secondary haemorrhage. At the last follow-up 2.5-9 years after presentation, the mean serum creatinine level (271.3 micromol/L) was significantly better than the mean preoperative level. Six patients are on maintenance haemodialysis. CONCLUSIONS It is not uncommon in developing countries for patients with urolithiasis to present with advanced uraemia caused by long-standing obstruction, almost invariably complicated by infection. A percutaneous endourological approach offers the best hope for these patients, and in our experience a significant percentage of these cases can be salvaged.
Collapse
Affiliation(s)
- M S Agrawal
- Urology Division, Department of Surgery, S.N. Medical College, Agra, India
| | | | | |
Collapse
|
|
37
|
Siwińska A, Głuszek J, Maciejewski J, Musialik D. Intravenous aminophylline increases the degree of saturation of urine with calcium phosphate and struvite. Int Urol Nephrol 1997; 29:141-6. [PMID: 9241539 DOI: 10.1007/bf02551333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was designed to assess the effect of i.v. treatment with aminophylline (AMPH) on the risk of calcium phosphate and struvite stone formation. We administered AMPH in doses of 4 mg/kg body weight in 15-min i.v. infusions to 60 infants with clinical symptoms of obstructive bronchitis with dyspnoea. During 3 hours after infusion we observed a significant increase in urine saturation with brushite, octocalcium phosphate and struvite. This rise in urine saturation may increase the risk of kidney stone formation.
Collapse
Affiliation(s)
- A Siwińska
- IInd Clinic of Paediatrics, University School of Medical Science, Poznań, Poland
| | | | | | | |
Collapse
|
|
38
|
Gupta M, Bolton DM, Gupta PN, Stoller ML. Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol 1994; 152:1086-90. [PMID: 8072069 DOI: 10.1016/s0022-5347(17)32509-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To our knowledge the prevalence of urinary stone disease and concurrent mild to moderate renal insufficiency has never been reported. A review of our last 2,000 urinary stone patients identified 33 (1.65%) with serum creatinine levels of 2.0 mg./dl. or greater at presentation. Chemical composition, location and complexity of the calculi, types of procedures required to render the patient stone-free and the effect of surgical intervention (independent of relief of obstruction) on renal function were evaluated. Mean serum creatinine level before surgical intervention and after placement of a ureteral stent or percutaneous nephrostomy tube in patients with evidence of obstruction was 3.2 mg./dl. (range 2.0 to 7.5). Complete or partial staghorn calculi were found in 21 of the 33 patients (64%), including 8 with bilateral staghorn calculi. Seven patients required 1 procedure, 1 required urinary alkalization alone and the other 25 required an average of 3.5 procedures each. Stone analysis revealed struvite, mixed calcium and uric acid to be the most common types. Followup creatinine values (the latest available within 1 year) and corresponding creatinine clearances showed remarkable improvement. The mean decrease in serum creatinine level was 1.2 mg./dl. (p < 0.001). There was no statistically significant difference in the rate of decrease between patients with pretreatment serum creatinine levels of 2.0 to 2.9 mg./dl. and those with initial values of 3.0 or more. Renal calculi and concurrent mild to moderate renal insufficiency warrant aggressive treatment. Patients demonstrate significant improvement in renal function independent of relief of obstruction.
Collapse
Affiliation(s)
- M Gupta
- Department of Urology, University of California School of Medicine, San Francisco
| | | | | | | |
Collapse
|