scholarly journals The effect of percutaneous nephrolithotomy in patients with chronic kidney disease in northeast India population

2021 ◽  
Vol 8 (5) ◽  
pp. 1458
Author(s):  
Phanindra Mohan Deka ◽  
Manharsinh Rajput ◽  
Priyanku Sarma

Background: Renal stone disease is a recognized precursor for renal deterioration, if untreated, it can lead to renal failure. With advances in the PCNL, the effect on patients with established renal insufficiency remains under reported. So, we aimed to evaluate the efficacy as well as safety of PCNL in chronic kidney disease patients.Methods: This retrospective cohort study included patients admitted in our hospital from January 2016 to December 2018, which were diagnosed with urolithiasis and chronic kidney disease and treated by PCNL. Patients with GFR <60 ml/min/1.73 m2 in non-obstructed renal stone disease who underwent PCNL were included. We studied the change in renal function, complete stone free rate (SFR) complications stone composition, operative time and hospital stay.Results: The study comprised 50 patients (M/F-32/18) of CKD who underwent PCNL. Mean operative time was 90.50±12.57minutes in group 1 and 98.00±12.35 minutes in group 2. One or more complications were noted in 12 patients (24%) after PCNL. At a mean follow-up of 18 months, renal function stage had improved in 24 patients (48%) and it was maintained in 13 (26%). Worse CKD with an increase in disease stage was noted in 13 patients (26%). Association between hypertension, diabetes and postoperative deterioration in kidney function wasn’t significant statistically (p=0.9). The stone-free rate at postoperative month 3 was 76%.Conclusions: PCNL has a favourable outcome in patients with chronic kidney disease stage III/IV, with a good calculus clearance rate and improved kidney function.

2021 ◽  
Author(s):  
Ching-Chia Li ◽  
Tsu-Ming Chien ◽  
Yen-Man Lu ◽  
Yii-Her Chou

Abstract Background: Urolithiasis is considered a vital public health issue with a substantial burden on kidney function. Additionally, only few reports focused on the gender difference in patients with urolithiasis. Therefore, this study aimed to compare the clinical characteristics of sex difference and their potential risk for chronic kidney disease (CKD) in patients with urolithiasis.Methods: Patients diagnosed with stone disease from 2013 to 2018 were retrospectively reviewed and divided into two groups by gender. Clinical demographic characteristics, stone location, stone composition, urine chemistries, and renal function were investigated. Univariate and multivariate analyses were used to assess the relationship and potential risk of CKD between sex groups.Results: A total of 1,802 stones were included: 1,312 from men and 490 from women. Female patients had higher rate of hypertension, diabetes, and dyslipidemia. Male patients predominantly had calcium-containing stones, especially calcium oxalate stone, uric acid stone, and struvite stone. Carbonate apatite stone was more frequently found in women. Complex surgeries such as percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) were more frequently performed in women than that in men. Multivariate analysis confirmed that age >60 years (odds ratios [ORs] = 6.36; 95% confidence interval [CI], 3.8–10.8), female sex (ORs = 5.31; 95% CI 3.3–8.4), uric acid stone (ORs = 3.55; 95% CI 2.0–6.4), hypertension (OR = 7.20; 95% CI 3.8–13.7), and diabetes (OR = 7.06; 95% CI 3.1–16.2) were independent predictors of poor prognoses in CKD.Conclusions: Gender is significantly associated with higher prevalence of CKD among patients with urolithiasis. Therefore, women with stone disease may need close renal function monitoring during follow-up.


2017 ◽  
Vol 313 (2) ◽  
pp. F547-F552 ◽  
Author(s):  
Davi A. Santana ◽  
Jacques R. Poortmans ◽  
Egidio Lima Dórea ◽  
Juliana Bannwart de Andrade Machado ◽  
Alan Lins Fernandes ◽  
...  

Exercise has been overlooked as a potential therapy in chronic kidney disease (CKD), mainly because of a lack of understanding on its safety aspects. Notably, there are no data on renal function after exercise in CKD considering its stages. We investigated the acute effects of a 30-min moderate-intensity aerobic exercise bout on glomerular filtration rate (GFR) and albuminuria in 22 nondialysis CKD patients divided into: CKD stages 1 and 2 (CKD1–2) and CKD stages 3 and 4 (CKD3–4). Eleven body mass index-, age-, and sex-matched healthy individuals served as control (CON). Blood and urine samples were collected before, immediately after, and up to 90 min postexercise for creatinine and albumin assessments. GFR was determined by creatinine clearance (GFRCr-Cl). All CKD patients had significantly lower peak oxygen uptake than CON. CKD1–2 and CKD3–4 had increasingly higher serum creatinine than CON (9.6 ± 2.6, 25.6 ± 1.01, and 7.5 ± 1.4 mg/l, respectively); however, no within-group changes in serum or urinary creatinine were observed across time. GFRCr-Cl was decreased in CKD1–2 and CKD3–4 compared with CON (91 ± 17 ml·min−1·1.73 m−2; 34 ± 15 ml·min−1·1.73 m−2; 122 ± 20 ml·min−1·1.73 m−2, respectively). Most importantly, exercise did not affect GFRCr-Cl in none of the groups across time. Albuminuria was significantly higher in CKD3–4 (297 ± 284 µg/min) than in CON (5.4 ± 1.4 µg/min), but no within-group changes were observed after exercise. In conclusion, a single 30-min moderate-intensity aerobic exercise bout does not impair renal function in nondialysis CKD patients, regardless of disease stage, supporting the notion that exercise training can be safe in this disease.


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S I Ragy ◽  
A A Elshorbagy ◽  
M A Alzqzouq

Abstract Objective Compare the outcomes of RIRS and PCNL for the treatment of 1 to 2 cm lower calyceal renal calculi regarding the stone free rate, operative time, fluoroscopy time, hospital stay and complication rate. Materials and Methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this randomized study. Patients were randomized into two groups: group 1: underwent RIRS (20pts); group 2: underwent PCNL (20 pts). Patients were evaluated with KUB and CT after one month. Results Mean fluoroscopy times and Hospital stay were significantly greater in the PCNL group than in RIRS group, In the RIRS group, the stone-free rate was 85% (17/20 patients); this rate increased to 95% after a second intervention. After a single PCNL procedure, 19 of 20 (95%) patients were completely stone free and For complications, there were minimal differences in both procedures, except for hemorrhage three patients who were treated with PCNL need blood transfusion Conclusions PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity., RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay.


2019 ◽  
Vol 18 (2) ◽  
pp. 42-47
Author(s):  
Bikash Bikram Thapa ◽  
Bina Basnet ◽  
Bikash Bahadur Rayamajhi ◽  
Narayan Thapa ◽  
Bharat Bhadur Bhandari

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy. Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value <0.05 was considered significant. Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin. Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.  


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