Selmi Volkan, Sarı Sercan, Caniklioğlu Mehmet, Öztekin Ünal, Taspinar Mehmet Sakir, Işıkay Levent
Urology, Yozgat Bozok University, Faculty of Medicine, Yozgat, TUR.
Urology, System Hospital, Kayseri, TUR.
Cureus. 2021 Jan 24;13(1):e12883. doi: 10.7759/cureus.12883.
Ureteral stones may have an influence on kidney functions due to postrenal obstruction or urinary infections. Urgent decompression or stone removal is necessary and recommended to prevent further complications in case of severe conditions such as anuria and urosepsis. Although it is believed that ureteral stone removal would result in renal function improvement, there are still unclear points on whether ureteroscopy (URS) can provide benefit as expected and has some adverse effects. In this study, we aimed to evaluate the alteration of kidney functions of patients who undergo rigid or flexible URS for ureteral stones and find if there are any influencing factors on kidney function alteration.
We analyzed 126 patients who underwent retrograde intrarenal surgery (RIRS) for renal stones between May 2018 and February 2020 prospectively. The estimated glomerular filtration rate (eGFR) was calculated on the day before the surgery, by modification of diet in renal disease (MDRD) formula. The calculation was repeated and saved three times during follow-up for the same patient; on the day after the operation, on the postoperative 30th day, and the postoperative 90th day. Then, we evaluated the renal function by comparing eGFR and assessed the predicting factors affecting the kidney function.
Preoperative mean eGFR was 82.28 ± 25.20 mL/min/1.73 m for the study group. Mean eGFR was calculated 90.92 ± 22.97 mL/min/1.73 m on the first postoperative day, and 94.54 ± 21.95 mL/min/1.73 m on the third-month follow-up. The mean change in eGFR was 8.63 ± 16.68 mL/min/1.73 m in the early period and 12.26 ± 21.09 mL/min/1.73 m in the long-term follow-up period. Fifty-one patients improved on chronic kidney disease (CKD) stage, and 13 deteriorated in three months follow-up.
Removing the stone and relieving the obstruction by ureteroscopic treatment have an alteration on eGFR. Although eGFR improves in the short-term follow-up, amelioration is evident in long-term follow-up, especially in female patients. The other predictive factors for eGFR improvement after URS are the presence of ureteral obstruction and high preoperative serum creatinine levels.
输尿管结石可能因肾后梗阻或泌尿系统感染而影响肾功能。在出现无尿和尿脓毒症等严重情况时，紧急减压或取石是必要的，也是推荐的，以防止进一步的并发症。尽管人们认为输尿管结石取出术会改善肾功能，但输尿管镜检查（URS）是否能如预期般带来益处以及是否存在一些不良反应仍不明确。在本研究中，我们旨在评估接受刚性或柔性URS治疗输尿管结石患者的肾功能变化，并找出影响肾功能变化的因素。
我们前瞻性分析了2018年5月至2020年2月期间接受逆行肾内手术（RIRS）治疗肾结石的126例患者。术前一天通过肾病饮食改良（MDRD）公式计算估计肾小球滤过率（eGFR）。在随访期间，对同一患者重复计算并保存三次；术后第一天、术后第30天和术后第90天。然后，我们通过比较eGFR评估肾功能，并评估影响肾功能的预测因素。
研究组术前平均eGFR为82.28±25.20 mL/min/1.73 m²。术后第一天平均eGFR为90.92±22.97 mL/min/1.73 m²，第三个月随访时为94.54±21.95 mL/min/1.73 m²。早期eGFR的平均变化为8.63±16.68 mL/min/1.73 m²，长期随访期为12.26±21.09 mL/min/1.73 m²。51例患者的慢性肾脏病（CKD）分期得到改善，13例在三个月随访中恶化。
输尿管镜治疗取石并解除梗阻会使eGFR发生改变。虽然短期随访中eGFR有所改善，但长期随访中改善更为明显，尤其是女性患者。URS术后eGFR改善的其他预测因素是输尿管梗阻的存在和术前血清肌酐水平较高。
