Satav Vikram P, Sharma Sonu, Kapoor Rohit, Sabale Vilas P, Shah Avreen Singh, Kandari Ashwani
Department of Urology and Renal Transplantation and Robotic Surgery, Dr. D. Y. Patil Medical College and Hospital, Pune, Mahrashtra, India.
Urol Ann. 2020 Jul-Sep;12(3):225-228. doi: 10.4103/UA.UA_122_19. Epub 2020 Jun 10.
Management of urolithiasis in patients with chronic kidney disease.
To ascertain the best method surgical or noninvasive.
This was a single-institute study.
A total of 50 patients of CKD with urolithiasis were enrolled in this comparative study. Clinical evaluation, biochemical evaluation, and radiological imaging were done. The management strategies were individualized to patient need. Following procedure, imaging and biochemical assessment were done to assess the stone clearance and improvement in the renal parameters. Intraoperative and postoperative complications are also noted. The patients were followed up to 6 months.
Statistical Package for the Social Sciences version 21.0 software was used for statistical analysis.
The mean age of the patients was 55.22 ± 10.76 years (range 28-76). Majority were male (76%) and had unilateral involvement. The mean preoperative hemoglobin (Hb), urea, creatinine, and total leukocyte count (TLC) were 9.49 ± 0.84 g%, 71.13 ± 24.09 mg/dl, 4.71 ± 2.45 mg/dl, and 8.67 ± 1.81 thousands/cumm, respectively. Percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) were the most common procedures performed in 23 (46%) and 12 (24%) patients, respectively. In 5 (10%) patients, PCNL with URSL was used. The clearance rate for different techniques ranged from 40% (PCNL with URSL) to 91.7% (URSL alone). The overall clearance rate was 78.3%. Fever (40%) and deranged renal function test requiring hemodialysis (16%) were the most common postoperative complications. Postoperatively, a significant decline in the mean Hb, serum (S.) urea, and S. creatinine was observed. The mean TLC levels showed a significant increase. During follow-up, S. creatinine levels showed consistent decline. Auxiliary procedures were needed in six (12%) cases. There were two (4%) mortalities.
The management of urolithiasis among CKD patients requires individualized approaches. The selection of appropriate strategy results in good outcome and minimum complications.
慢性肾脏病患者尿路结石的管理。
确定最佳方法（手术或非侵入性）。
这是一项单机构研究。
本比较研究共纳入50例患有尿路结石的慢性肾脏病患者。进行了临床评估、生化评估和影像学检查。管理策略根据患者需求个体化制定。术后进行影像学和生化评估，以评估结石清除情况和肾脏参数的改善情况。还记录了术中及术后并发症。对患者进行了6个月的随访。
使用社会科学统计软件包21.0版软件进行统计分析。
患者的平均年龄为55.22±10.76岁（范围28 - 76岁）。大多数为男性（76%），且为单侧受累。术前平均血红蛋白（Hb）、尿素、肌酐和白细胞总数（TLC）分别为9.49±0.84 g%、71.13±24.09 mg/dl、4.71±2.45 mg/dl和8.67±1.81千/立方毫米。经皮肾镜取石术（PCNL）和输尿管镜碎石术（URSL）是最常见的手术，分别在23例（46%）和12例（24%）患者中进行。5例（10%）患者采用了PCNL联合URSL。不同技术的清除率范围为40%（PCNL联合URSL）至91.7%（单纯URSL）。总体清除率为78.3%。发热（40%）和需要血液透析的肾功能检查异常（16%）是最常见的术后并发症。术后，平均Hb、血清尿素和血清肌酐显著下降。平均TLC水平显著升高。随访期间，血清肌酐水平持续下降。6例（12%）患者需要辅助手术。有2例（4%）死亡。
慢性肾脏病患者尿路结石的管理需要个体化方法。选择合适的策略可带来良好的结果和最少的并发症。
