Reich Daniel A, Adiyeke Esra, Ozrazgat-Baslanti Tezcan, Rabley Andrew K, Bozorgmehri Shahab, Bihorac Azra, Bird Vincent G
University of Florida College of Medicine, Gainesville, FL 32610, USA.
Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Biomedicines. 2023 Jun 14;11(6):1712. doi: 10.3390/biomedicines11061712.
Acute kidney injury (AKI) is a common postoperative outcome in urology patients undergoing surgery for nephrolithiasis. The objective of this study was to determine the prevalence of postoperative AKI and its degrees of severity, identify risk factors, and understand the resultant outcomes of AKI in patients with nephrolithiasis undergoing percutaneous nephrolithotomy (PCNL). A cohort of patients admitted between 2012 and 2019 to a single tertiary-care institution who had undergone PCNL was retrospectively analyzed. Among 417 ( = 326 patients) encounters, 24.9% ( = 104) had AKI. Approximately one-quarter of AKI patients ( = 18) progressed to Stage 2 or higher AKI. Hypertension, peripheral vascular disease, chronic kidney disease, and chronic anemia were significant risk factors of post-PCNL AKI. Corticosteroids and antifungals were associated with increased odds of AKI. Cardiovascular, neurologic complications, sepsis, and prolonged intensive care unit (ICU) stay percentages were higher in AKI patients. Hospital and ICU length of stay was greater in the AKI group. Provided the limited literature regarding postoperative AKI following PCNL, and the detriment that AKI can have on clinical outcomes, it is important to continue studying this topic to better understand how to optimize patient care to address patient- and procedure-specific risk factors.
急性肾损伤(AKI)是接受肾结石手术的泌尿外科患者常见的术后结局。本研究的目的是确定经皮肾镜取石术(PCNL)治疗肾结石患者术后AKI的患病率及其严重程度,识别危险因素,并了解AKI的最终结局。对2012年至2019年期间入住一家三级医疗机构并接受PCNL的患者队列进行回顾性分析。在417例(n = 326例患者)病例中,24.9%(n = 104)发生了AKI。约四分之一的AKI患者(n = 18)进展为2期或更高分期的AKI。高血压、外周血管疾病、慢性肾脏病和慢性贫血是PCNL术后AKI的显著危险因素。使用皮质类固醇和抗真菌药物会增加发生AKI的几率。AKI患者发生心血管、神经并发症、脓毒症以及入住重症监护病房(ICU)时间延长的比例更高。AKI组的住院时间和ICU住院时间更长。鉴于关于PCNL术后AKI的文献有限,且AKI会对临床结局产生不利影响,继续研究该主题以更好地了解如何优化患者护理以应对患者和手术特定的危险因素非常重要。