Department of Urology, Shanghai Changhai Hospital, Shanghai, China.
Department of Radiology, Shanghai Changhai Hospital, Shanghai, China.
BJU Int. 2018 Oct;122(4):633-638. doi: 10.1111/bju.14413. Epub 2018 Jun 19.
To evaluate renal function changes and risk factors for acute kidney injury (AKI) after percutaneous nephrolithotomy (PCNL) in patients with renal calculi with a solitary kidney (SK) or normal bilateral kidneys (BKs).
Between 2012 and 2016, 859 patients undergoing PCNL were retrospectively reviewed at Changhai Hospital. In all, 53 patients with a SK were paired with 53 patients with normal BKs via a propensity score-matched analysis. Data for the following variables were collected: age, sex, body mass index, stone size, distribution, operation time, perioperative outcomes, and complications. The complications were graded according to the modified Clavien-Dindo system. Univariable and multivariable logistic regression models were constructed to evaluate risk factors for predicting AKI.
The SK and BKs groups were comparable in terms of age, sex ratio, stone size, stone location distribution, comorbidities, and American Society of Anesthesiologists Physical Status classification. The initial and final stone-free rates were comparable between the SK and BKs groups (initial: 52.83% vs 58.49%, P = 0.696; final: 84.91% vs 92.45%, P = 0.359). There was no difference between the two groups for complications, according to the Clavien-Dindo grades. The estimated glomerular filtration rate (eGFR) increased dramatically after the stone burden was immediately relieved, and during the 6-month follow-up eGFR was lower in the SK group compared with the BKs group. We found a modest improvement in renal function immediately after PCNL in the BKs group, and renal function gain was delayed in the SK group. Through logistic regression analysis, we discovered that a SK, preoperative creatinine and diabetes were independent risk factors for predicting AKI after PCNL.
Considering the overall complication rates, PCNL is generally a safe procedure for treating renal calculi amongst patients with a SK or normal BKs. Follow-up renal function analysis showed a modest improvement in patients of both groups. Compared to patients with normal BKs, patients with a SK were more likely to develop AKI after PCNL.
评估肾结石伴孤立肾（SK）或正常双肾（BKs）患者经皮肾镜碎石取石术（PCNL）后肾功能变化及急性肾损伤（AKI）的危险因素。
2012 年至 2016 年，回顾性分析长海医院 859 例行 PCNL 患者的临床资料。对 53 例 SK 患者与 53 例正常 BKs 患者进行倾向评分匹配分析。收集年龄、性别、体重指数、结石大小、分布、手术时间、围手术期结果和并发症等数据。并发症根据改良 Clavien-Dindo 系统分级。采用单变量和多变量逻辑回归模型评估预测 AKI 的危险因素。
SK 组与 BKs 组在年龄、性别比、结石大小、结石位置分布、合并症和美国麻醉医师协会身体状况分类方面无差异。SK 组与 BKs 组初始和最终结石清除率无差异（初始：52.83% vs 58.49%，P = 0.696；最终：84.91% vs 92.45%，P = 0.359）。两组间并发症根据 Clavien-Dindo 分级无差异。结石负荷立即缓解后，估算肾小球滤过率（eGFR）显著升高，6 个月随访时 SK 组 eGFR 低于 BKs 组。我们发现 BKs 组 PCNL 后肾功能即刻改善，而 SK 组肾功能改善延迟。通过逻辑回归分析，我们发现 SK、术前肌酐和糖尿病是 PCNL 后预测 AKI 的独立危险因素。
考虑到总体并发症发生率，PCNL 治疗肾结石在 SK 或正常 BKs 患者中通常是一种安全的手术。随访肾功能分析显示两组患者肾功能均有一定程度改善。与正常 BKs 患者相比，SK 患者 PCNL 后更易发生 AKI。
