Department of Urology, Montefiore Medical Center, Bronx, USA.
Albert Einstein College of Medicine, Bronx, USA.
Urolithiasis. 2019 Oct;47(5):449-453. doi: 10.1007/s00240-019-01113-5. Epub 2019 Feb 12.
To compare renal functional outcomes in patients with and without chronic kidney disease (CKD) to identify predictors of change in renal function after percutaneous nephrolithotomy (PCNL). We reviewed patients who underwent PCNL by a single surgeon over 3.5 years. Patients' pre- and post-operative Glomerular Filtration Rate (GFR) was calculated. Baseline GFR < 60 ml/min/1.73 m (stage ≥ 3 CKD) defined our CKD cohort. Patients' baseline renal function, comorbidities, stone parameters, and intra-operative variables were analyzed to determine the relationship with post-operative renal function after PCNL by multivariate analysis. 202 patients were analyzed. Mean follow-up time was 16 months. At baseline, 163 (80.7%) patients were free of CKD and 39 (19.3%) had CKD. Patients without CKD had an overall decrease in GFR from 105.6 to 103.3 ml/min/1.73 m (p = 0.494). 14/163 (8.6%) non-CKD patients experienced a significant decline in renal function after PCNL; 7/163 (4.3%) developed de novo CKD and 7 had a ≥ 30% decline in GFR. Patients with CKD had an overall increase in mean GFR post-operatively, from 47.3 to 54.0 ml/min/m (p = 0.067). Two in this cohort (5.1%) experienced a > 30% decline in renal function post-operatively. Age, gender, African American race, presence of comorbidities and pre-operative CKD were not significant predictors of renal function post-operatively on multivariate analysis. PCNL in this cohort appears GFR neutral in the setting of baseline CKD. CKD was not predictive of renal functional decline after PCNL. Given that stone disease carries a high recurrence rate and that CKD is associated with stone formers, further investigation into predictors of renal function change after PCNL is warranted.
比较有和无慢性肾脏病（CKD）的患者的肾功能结局，以确定经皮肾镜碎石取石术（PCNL）后肾功能变化的预测因素。我们回顾了 3.5 年内由一位外科医生进行的 PCNL 的患者。计算了患者术前和术后的肾小球滤过率（GFR）。基线 GFR<60ml/min/1.73m（≥3 期 CKD）定义为我们的 CKD 队列。通过多元分析分析患者的基线肾功能、合并症、结石参数和术中变量与 PCNL 后术后肾功能的关系。对 202 例患者进行了分析。平均随访时间为 16 个月。基线时，163 例（80.7%）患者无 CKD，39 例（19.3%）有 CKD。无 CKD 的患者 GFR 总体从 105.6 降至 103.3ml/min/1.73m（p=0.494）。163 例非 CKD 患者中，14 例（8.6%）在 PCNL 后肾功能明显下降；7 例（4.3%）新发 CKD，7 例 GFR 下降≥30%。CKD 患者术后平均 GFR 总体增加，从 47.3 增加到 54.0ml/min/m（p=0.067）。这一组中有 2 例（5.1%）术后肾功能下降>30%。多变量分析显示，年龄、性别、非裔美国人种族、合并症和术前 CKD 不是术后肾功能的显著预测因素。在基线 CKD 的情况下，PCNL 对 GFR 似乎是中性的。CKD 不是 PCNL 后肾功能下降的预测因素。鉴于结石病的复发率很高，且 CKD 与结石形成者相关，因此需要进一步研究 PCNL 后肾功能变化的预测因素。
