Department of Urology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Urology. 2012 May;79(5):990-4. doi: 10.1016/j.urology.2011.10.066. Epub 2012 Feb 4.
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.
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.
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.
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.
介绍肾结石和慢性肾脏病患者的长期随访数据，以确定有助于预测肾功能长期恶化的因素。
2002 年 1 月至 2010 年 7 月，我们对 1051 例患者的 1117 例经皮肾镜取石术（PNL）进行了回顾性分析。我们对 67 例（47 名男性和 20 名女性）患者的 69 例 PNL 手术进行了回顾性分析，这些患者的估算肾小球滤过率（eGFR）<60mL/min/1.73m2。测量了两个结果。通过比较术前和术后值来测量 eGFR 的变化百分比。为了将人群分为 3 组，我们选择了 5%的肾功能变化：组 1，eGFR 变化≤5%；组 2，eGFR 增加>5%；组 3，eGFR 降低<5%。第二个结果测量是在第一年内和连续年内是否出现慢性肾脏病进展。
患者平均年龄为 57±14.1 岁。根据 Clavien 分类，并发症发生率为 23.1%。平均随访时间为 45.7±17.08 个月。PNL 前后的平均 eGFR 分别为 37.9±14.05 和 45.1±16.8。多变量分析显示，糖尿病（优势比 15.82，P=.036）和尿路感染（优势比 10.6，P=.04）是 1 年后肾功能恶化的预测因素。
PNL 治疗慢性肾脏病患者安全有效，可在 5 年内保存肾功能。糖尿病和尿路感染是肾功能损害的独立预测因素。因此，患有糖尿病和尿路感染的患者应密切随访，并告知他们这些疾病的潜在危险。
