Sninsky Brian C, Jhagroo R Allan, Astor Brad C, Nakada Stephen Y
1 Department of Urology, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin.
J Endourol. 2014 Nov;28(11):1295-8. doi: 10.1089/end.2014.0322. Epub 2014 Aug 14.
Although considered standard of care for symptomatic urolithiasis, few data are available that evaluate the effects of multiple ureteroscopies (URS) with laser lithotripsies on long-term renal function. We investigated this relationship in a population with preexisting mild to moderate kidney disease. Previous studies have been limited by estimates of glomerular filtration rate (eGFR) calculated from creatinine level during acute stone obstruction, and inclusion of patients with a history of other stone procedures, such as shockwave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL).
Charts were reviewed for patients with a baseline eGFR below 90 mL/min/1.73 m(2) who underwent at least two URS for nephrolithiasis at our institution from 2004 to 2012. Patients undergoing SWL or PCNL at any point in their history were excluded. A total of 26 patients, with a mean of 2.3±0.6 URS procedures, were included. The eGFR was recorded at baseline before acute stone presentation and surgery, and at the last recorded follow-up visit. Stone location, total stone burden, and comorbidities were also recorded.
The mean eGFR changed from 68.0±13.3 to 75.4±23.0 mL/min/1.73m(2) (mean increase of 10.1±25.0%; mean annual increase of 3.8±15.3%) over a mean follow-up period of 28.1 months (range 5-75 mos). There was no significant difference in eGFR change between patients with stones treated in the kidney alone vs the ureter and kidney combined (12.1% vs 8.3% mean increase; P=0.74). Age, presence of diabetes mellitus or hypertension, baseline creatinine level, total stone burden, and number of URS performed were not significantly associated with change in eGFR.
Using eGFR measured before acute stone presentation, our results suggest that multiple ureteroscopies for stones are not detrimental to long-term renal function, even in patients with preexisting stage 2-3 chronic kidney disease.
尽管输尿管镜检查（URS）联合激光碎石术被视为有症状尿路结石的标准治疗方法，但评估多次输尿管镜检查对长期肾功能影响的数据却很少。我们在患有轻度至中度肾病的人群中研究了这种关系。以往的研究受到急性结石梗阻期间根据肌酐水平计算的肾小球滤过率（eGFR）估计值的限制，并且纳入了有其他结石治疗史的患者，如冲击波碎石术（SWL）或经皮肾镜取石术（PCNL）。
回顾了2004年至2012年在我们机构接受至少两次URS治疗肾结石且基线eGFR低于90 mL/min/1.73m²的患者病历。排除有过SWL或PCNL治疗史的患者。共纳入26例患者，平均接受2.3±0.6次URS治疗。在急性结石发作和手术前的基线以及最后一次记录的随访时记录eGFR。还记录结石位置、结石总负荷和合并症。
在平均28.1个月（范围5 - 75个月）的随访期内，平均eGFR从68.0±13.3变为75.4±23.0 mL/min/1.73m²（平均增加10.1±25.0%；平均每年增加3.8±15.3%）。单纯肾结石治疗患者与输尿管和肾结石联合治疗患者的eGFR变化无显著差异（平均增加12.1%对8.3%；P = 0.74）。年龄、糖尿病或高血压的存在、基线肌酐水平、结石总负荷和URS治疗次数与eGFR变化无显著相关性。
使用急性结石发作前测量的eGFR，我们的结果表明，即使在已有2 - 3期慢性肾病的患者中，多次输尿管镜取石术对长期肾功能也无损害。
