Department of Urology, Global Hospitals and Health City, Chennai, Tamil Nadu, India.
J Urol. 2012 Oct;188(4):1195-200. doi: 10.1016/j.juro.2012.06.027. Epub 2012 Aug 15.
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.
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.
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.
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.
我们根据术前肾功能比较了接受经皮肾镜取石术治疗的患者在 CROES（腔内泌尿外科学研究组织）全球研究中的特点和结局。
前瞻性收集了 96 个参与中心在 1 年期间连续接受经皮肾镜取石术治疗的患者数据。基于术前血清肌酐测量，使用基于肾脏病饮食改良公式估算肾小球滤过率。患者根据肾小球滤过率分为 3 组，包括慢性肾脏病 0/Ⅰ/Ⅱ期-大于 60、Ⅲ期-30 至 59 和Ⅳ/Ⅴ期-小于 30ml/min/1.73m²。评估了患者特征、手术特征、结局和发病率。
5644 例患者的估算肾小球滤过率数据可用，包括 4436 例慢性肾脏病 0/Ⅰ/Ⅱ期、994 例慢性肾脏病 Ⅲ期和 214 例慢性肾脏病 Ⅳ/Ⅴ期。患有肾结石的患者中，有一小部分患有严重的慢性肾脏病。与肾功能受影响较小的患者相比，患有慢性肾脏病 Ⅳ/Ⅴ期的患者以前接受过经皮肾镜取石术、输尿管镜检查或肾造口术，且尿液培养阳性的患者更多，这与这些患者中鹿角形结石的发生率更高有关。慢性肾脏病 Ⅳ/Ⅴ期患者的术后结局明显比其他慢性肾脏病组差。
肾功能不良对经皮肾镜取石术后结局有负面影响。通过初次就诊时更积极地清除肾结石，特别是鹿角形结石，并通过控制感染、药物或其他干预措施更警惕地预防复发，可以减轻肾结石引起的慢性肾脏病进展。
