Göger Yunus Emre, Özkent Mehmet Serkan, Kılınç Muzaffer Tansel, Erol Eren, Taşkapu Hakan Hakkı
Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey.
Department of Urology, Konya City Hospital, Konya, Turkey.
World J Urol. 2023 Mar;41(3):857-864. doi: 10.1007/s00345-023-04301-6. Epub 2023 Jan 31.
To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS).
The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis.
This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors.
Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.
探讨逆行性肾内手术（RIRS）后急性肾损伤（AKI）的影响因素。
回顾性分析2018年1月至2022年6月在两家三级中心接受肾结石RIRS手术患者的数据。获取患者的人口统计学数据。根据改善全球肾脏病预后组织（KDIGO）标准，将发生AKI和未发生AKI的患者分为两组。对两组患者术前、术中和术后的预测因素进行研究。此外，通过多因素分析检查AKI的影响因素。
本研究包括295名（35.7%）女性和532名（64.3%）男性。平均年龄为50.03±15.4岁（范围18 - 89岁），平均结石大小为15.5±6.1毫米（范围6 - 47毫米）。总体而言，672例患者（81.3%）在初始治疗后结石清除。根据KDIGO标准，110例患者（13.3%）在术后发生AKI。单因素分析显示，结石大小（P = 0.003）、既往结石手术史（P = 0.010）、肾脏畸形（P = 0.017）、手术时间长（P = < 0.001）、术前肌酐值高（P = 0.036）、术中并发症（P = 0.018）和术后尿路感染（P = 0.003）对RIRS术后的AKI有显著影响。多因素分析将既往结石手术史、术前肌酐值高、肾脏畸形和术中并发症排除在逻辑回归模型之外，而其他因素对AKI仍具有统计学显著影响，表明它们是独立预测因素。
结石大小、手术时间、术后尿路感染和糖尿病是AKI的重要预测因素。在RIRS期间，泌尿外科医生应考虑增加AKI风险的因素，并基于这些因素评估治疗效果。
