scholarly journals Renal function evaluation after percutaneous nephrolithotomy in patients with solitary kidney

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Early Postoperative Period ◽  
Function Evaluation ◽  
Time Duration

Objective: To evaluate renal function change after percutaneous nephrolithotomy in patients with solitary kidney. Methods: A prospective study conducted in the urology department at Rizgary Teaching Hospital for a period of 15 months from first of June 2018 until the end of August 2019. It included nine adult patients, all of them with solitary kidney and undergone percutaneous nephrolithotomy for management of renal calculi. Patients were considered to have a solitary kidney in case of congenital abnormality, contralateral nephrectomy, or solitary functioning kidney with contralateral atrophy (relative function < 10%). All patients were received prophylactic antibiotics (Ceftriaxone) at induction of anesthesia. All percutaneous nephrolithotomy procedures performed under general anesthesia in the prone position. Serum creatinine and creatinine clearance before the operation, at day one and day 21 postoperatively, operation time, duration of hospitalization, and postoperative complications recorded. Results: In this study, Means of serum creatinine at 1 day and 21 days postoperatively were significantly decreased compared to preoperative s. creatinine level Mean of creatinine clearance significantly increased after 21 days postoperatively compared to preoperative test, while no significant change in creatinine clearance after one day postoperatively. Conclusion: Generally, percutaneous nephrolithotomy considered as a safe and effective option for treatment of renal stones in solitary kidney patients considering the overall rate of complications and minimal morbidity. Moreover, significant renal function improvement anticipated in the early postoperative period.

Percutaneous nephrolithotomy vs. retrograde intrarenal surgery for renal stones larger than 2cm in patients with a solitary kidney: A systematic review and a meta-analysis

2019 ◽  
Author(s):  
Kehua Jiang ◽  
Guangheng Luo ◽  
Jianxing Hu ◽  
Jianguo Zhu ◽  
Fa Sun
Keyword(s):  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Systematic Evaluation ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Retrograde Intrarenal Surgery

Abstract Background: The safety and feasibility of percutaneous nephrolithotomy (PCNL) compared with retrograde intrarenal surgery (RIRS) are debated. This systematic evaluation was performed to obtain comprehensive evidence with regard to the treatment outcomes of PCNL compared with RIRS for management of renal stones in patients with solitary kidney. Methods: A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared PCNL with RIRS. Outcomes of interest included perioperative variables, complications, and stone-free rate (SFR). Results: 4 studies assessing PCNL vs. RIRS were included for meta-analysis. Although patients underwent PCNL have higher initial SFR than RIRS (OR: 3.72, 95% CI:2.38 to 5.83; P＜0.001), patients underwent RIRS have less intraoperative blood loss (dropped Hb: WMD= 3.49 g/L, 95% CI:2.83 to 4.15; P＜0.001), lower blood transfusion rates (OR= 5.31, 95% CI:1.36 to 20.68; P=0.02), and higher incidence rate of steinstrasse (OR:0.20, 95% CI:0.04 to 0.91; P=0.04). All the other calculated results including operation time (WMD: -9.87 minute, 95% CI:-30.11 to 10.37; P=0.34), final SFR (OR:1.65, 95% CI:0.80 to 3.42;P=0.18) and overall complications (OR:1.22, 95% CI:0.78 to 1.93; P=0.38) are similar between the two groups. Conclusions: Our results indicate that PCNL has higher initial SFR than RIRS in the treatment of renal stones in patients with a solitary kidney; the overall complications were comparable in both groups. However, RIRS, with less blood loss and transfusion rate, may be an alternative in selected patients.

scholarly journals The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1–3 cm renal stones and risk factors of renal function changes

Renal Failure ◽  
2021 ◽  
Vol 43 (1) ◽  
pp. 264-272
Author(s):  
Yang Pan ◽  
Han Chen ◽  
Hualin Chen ◽  
Xiaoxiang Jin ◽  
Yunxiao Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Flexible Ureteroscopy ◽  
One Stage

Assessment of possible nephrotoxicity from iohexol in patients with normal and impaired renal function

1998 ◽  
Vol 39 (4) ◽  
pp. 362-367 ◽  
Author(s):  
S. Lundqvist ◽  
G. Holmberg ◽  
G. Jakobsson ◽  
F. Lithner ◽  
K. Skinningsrud ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Adverse Events ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Impaired Renal Function ◽  
Urine Protein ◽  
Urine Protein Excretion ◽  
Protein Excretion ◽  
Patients With Diabetes

Purpose: To evaluate the possible nephrotoxic effects of iohexol in patients with normal and impaired renal function. Material and Methods: A prospective urographic study using iohexol (50 ml, 300 mg I/ml) was performed in 100 patients, 63 with impaired renal function (IRF) and 37 with normal renal function (NRF). The group included 24 patients with diabetes mellitus, 17 of them with IRF. Renal function parameters and adverse events were recorded for one week after the urography. Results: There were no significant changes in serum creatinine, creatinine clearance, or β-2-microglobulin. The 24-h urine protein excretion showed a statistically significant increase in patients with NRF as well as in patients with IRF. Nine patients experienced adverse events but none of them required any treatment. Conclusion: Iohexol was tolerated well in patients with NRF and in patients with IRF without significant overall nephrotoxic effects. Some minor adverse events were recorded.

Low-flow Sevoflurane Compared with Low-flow Isoflurane Anesthesia in Patients with Stable Renal Insufficiency

2002 ◽  
Vol 97 (3) ◽  
pp. 578-584 ◽  
Author(s):  
Peter F. Conzen ◽  
Evan D. Kharasch ◽  
Stephan F. A. Czerner ◽  
Alan A. Artru ◽  
Florian M. Reichle ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Blood Urea Nitrogen ◽  
Gas Flow ◽  
Minimum Alveolar Concentration ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Urine Protein

Background Sevoflurane is degraded to compound A (CpA) by carbon dioxide absorbents containing strong base. CpA is nephrotoxic in rats. Patient exposure to CpA is increased with low fresh gas flow rates, use of Baralyme, and high sevoflurane concentrations. CpA formation during low-flow and closed circuit sevoflurane anesthesia had no significant renal effects in surgical patients with normal renal function. Preexisting renal insufficiency is a risk factor for postoperative renal dysfunction. Although preexisting renal insufficiency is not affected by high-flow sevoflurane, the effect of low-flow sevoflurane in patients with renal insufficiency is unknown. Methods After obtaining institutional review board approval, 116 patients with a stable preoperative serum creatinine concentration 1.5 mg/dl or greater were assessable. Patients were randomized to receive either sevoflurane (n = 59, 0.8-2.5 vol%) or isoflurane (n = 57, 0.5-1.4 vol%) at a fresh gas flow rate of 1 l/min or less. Use of opioids was restricted to a minimum, and Baralyme was used to increase CpA exposure. Inspiratory and expiratory CpA concentrations were measured during anesthesia. Renal function (serum creatinine and blood urea nitrogen, urine protein and glucose, creatinine clearance) was measured preoperatively and 24 and 72 h after induction. Results Demographic patient data did not differ between groups. Patients received 3.1 +/- 2.4 minimum alveolar concentration-hours sevoflurane or 3.8 +/- 2.6 minimum alveolar concentration-hours isoflurane (mean +/- SD). Durations of low flow were 201.3 +/- 98.0 and 213.6 +/- 83.4 min, respectively. Maximum inspiratory CpA with sevoflurane was 18.9 +/- 7.6 ppm (mean +/- SD), resulting in an average total CpA exposure of 44.0 +/- 30.6 ppm/h. There were no statistically significant changes from baseline to 24- and 72-h values for serum creatinine or blood urea nitrogen, creatinine clearance, urine protein, and glucose, nor were there significant differences between both anesthetics. Conclusion There were no statistically significant differences in measured parameters of renal function after low-flow sevoflurane anesthesia compared with isoflurane. These results suggest that low-flow sevoflurane anesthesia is as safe as low-flow isoflurane and does not alter kidney function in patients with preexisting renal disease.

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

2014 ◽  
Vol 94 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Wen Zhong ◽  
Zhijian Zhao ◽  
Liang Wang ◽  
Sunil Swami ◽  
Guohua Zeng
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Staghorn Calculi ◽  
Combined Use ◽  
Stone Free Rate ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

scholarly journals Renal Function Evaluation in Secondary Amyloidosis According to Location of Deposition

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Serhat Özçelik ◽  
Gülizar Manga Şahin
Keyword(s):  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Renal Biopsy ◽  
Amyloid Deposition ◽  
Function Evaluation ◽  
Secondary Amyloidosis ◽  
Renal Functions ◽  
Group 2 ◽  
Time Of Presentation

It aimed to evaluate the renal functions according to the accumulation site of amyloid in patients diagnosed with secondary amyloidosis by renal biopsy. Fifty patients diagnosed with secondary amyloidosis, who referred to the nephrotic syndrome outpatient clinic included in the study. According to the findings of renal biopsy, only-glomerular amyloid deposition (group- 1) detected in 9 patients and glomerular+ tubulointerstitial deposition (group- 2) identified in 41 patients. Serum creatinine, creatinine clearance, and total proteinuria levels compared between groups at the time of presentation and on 3rd, 6th, 12th, and 24th months. Initial and subsequent serum creatinine, creatinine clearance, and total proteinuria levels not found to be significantly different between groups (p>0,05 for all). Among subjects with only-glomerular deposition, statistically significant descents in total proteinuria, when compared to initial levels, were observed from the beginning of the 6th month to the end of the 24th month (p<0,05). On the other hand, subjects with both glomerular + tubulointerstitial deposition, statistically significant descents in total proteinuria levels observed from the beginning of follow-up to the end of the 24th month (p<0,01). In subjects with both glomerular + tubulointerstitial accumulation, a statistically significant increase in serum creatinine, compared to baseline levels, observed in 12th and 24th months (p<0,01). According to the biopsy findings, progressive deterioration of renal functions and an increase in proteinuria were higher in patients with both glomerular and tubulointerstitial amyloid deposition than patients with only-glomerular removal.

scholarly journals Providing Several Skills to Treat Complex Infectious Stones of Solitary Kidney in a Patient Failed to Undergo Percutaneous Nephrolithotomy: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Dechao Feng ◽  
Wuran Wei
Keyword(s):  
Cost Effectiveness ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Laser Lithotripsy ◽  
High Frequency Oscillation ◽  
Flexible Ureteroscopy ◽  
Renal Deterioration ◽  
Holmium Laser Lithotripsy ◽  
Staghorn Stones

Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.

scholarly journals Effects of Renal Function Evaluation with or without Serum Creatinine Adjustment on Cisplatin/Fluorouracil Therapy for Cervical Cancer

2019 ◽  
Vol 139 (10) ◽  
pp. 1327-1332
Author(s):  
Mai Takagi ◽  
Atsunobu Sagara ◽  
Ayumi Ishizawa ◽  
Ayaka Ito ◽  
Masayuki Miyazaki ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Renal Function ◽  
Serum Creatinine ◽  
Function Evaluation

scholarly journals Percutaneous nephrolithotomy assisted by LithoClast master in one-phase treatment for staghorn renal stones with refractory infections

2020 ◽  
Author(s):  
Hai-Xiao Tang ◽  
Di Wu ◽  
Bo-Wen Shi ◽  
Ze-Hao Dai ◽  
Yun-Teng Huang
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Medical Center ◽  
Operation Time ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Medical Systems ◽  
Two Phase ◽  
Reactive Protein ◽  
Fifth Generation ◽  
Grade Ii

Abstract Background: Infectious staghorn renal stones are usually treated with one-phase for percutaneous puncture and drainage, and then two-phase for percutaneous nephrolithotomy (PCNL). The objective of the study was to evaluate the efficacy and safety of PCNL assisted by LithoClast master (the fifth-generation Electro Medical Systems, EMS) in one-phase treatment for staghorn renal stones with refractory infections.Methods: From September 2017 to September 2019, 80 patients with staghorn renal stones who underwent one-phase for PCNL combined with the fifth-generation EMS in our hospital were retrospectively analyzed. According to whether patients with staghorn renal stones were complicated with refractory infections or not before operation, they were divided into A group (48 cases with refractory infections) and B group (32 cases without infections). In A group, refractory infections were properly controlled with sensitive antibiotics before operation. The efficacy and safety of treatment for two groups were compared.Results: Before taking sensitive antibiotics in A group, there was statistical difference in the location of stones between the two groups (P＜0.05), while there were no statistical significances in other general clinical data between the two groups (P＞0.05). Although there were statistical differences in the increase rate of white blood cell count, C-reactive protein, procalcitonin on the first day after operation between the two groups (P＜0.05), there were no statistical differences in operation time, hospitalization time, hemoglobin, stone-free rate, Clavien-Dindo grade I complications, Clavien-Dindo grade II and above complications between the two groups (P＞0.05). Conclusions: For staghorn renal stones with refractory infections, based on the application of sensitive antibiotics before operation to properly control refractory infections, PCNL assisted by the fifth-generation EMS in one-phase can efficiently remove staghorn renal stones, without increasing the risk of postoperative complications. In the medical center with mature technical conditions and rich experience, staghorn renal stones with refractory infections can be selected carefully to carry out one-phase operation.

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