Urology Department, Faculty of Medicine, South Valley University, Qena, Egypt.
Urology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
Int Urol Nephrol. 2024 Jun;56(6):1843-1850. doi: 10.1007/s11255-024-03960-7. Epub 2024 Jan 30.
To assess the frequency and the predictive factors of Acute Kidney injury (AKI) in patients undergoing percutaneous nephrolithotomy (PNL).
A prospective observational work. Demographic, preoperative laboratory data, stone characteristics, and intraoperative and postoperative data were gathered. Perioperative AKI had been defined as an elevation in serum creatinine by ≥ 0.3 mg/dl within 48 h, or ≥ 1.5 times baseline, or urine volume less than 0.5 ml/ kg/hour for 6 hours. A multivariate logistic regression analysis was performed to determine the predictive factors of AKI. ROC curves were utilized to determine the cutoff values of the risk variables. P-values were deemed statistically significant when they were less than 0.05.
A total of 418 participants had been involved. The frequency of AKI was 13.9, and 17.2% of patients with AKI developed CKD. The risk factors were age > 46.5 years, smoking, BMI > 28.5 kg/m, hypertension, diabetes, utilization of angiotensin-converting enzyme inhibitors (ACEI), haemoglobin < 10.8 gm/dl, baseline creatinine > 1.41 mg/dl, eGFR < 65.2 ml/min./1.73 m, serum uric acid > 5.2 mg/dl, stone volume > 1748 mm, large tract size, long operative time, and intra-operative bleeding. Patients with AKI had a notably extended duration of hospitalization (3.2 days ± 0.45 vs 2.1 ± 0.42, p < 0.001).
Perioperative AKI occurred in 13.9% of individuals undergoing PNL. Identification and optimization of the risk factors and meticulous technique during PNL procedures should be attempted to decrease the risk of AKI.
评估经皮肾镜取石术（PNL）患者发生急性肾损伤（AKI）的频率及预测因素。
前瞻性观察性研究。收集患者的人口统计学、术前实验室数据、结石特征以及术中、术后数据。围手术期 AKI 定义为血清肌酐在 48 小时内升高≥0.3mg/dl，或基线升高≥1.5 倍，或 6 小时内尿量小于 0.5ml/kg/h。采用多变量逻辑回归分析确定 AKI 的预测因素。ROC 曲线用于确定风险变量的临界值。P 值小于 0.05 被认为具有统计学意义。
共纳入 418 例患者。AKI 的发生率为 13.9%，17.2%的 AKI 患者发生 CKD。危险因素包括年龄＞46.5 岁、吸烟、BMI＞28.5kg/m、高血压、糖尿病、使用血管紧张素转换酶抑制剂（ACEI）、血红蛋白＜10.8g/dl、基线肌酐＞1.41mg/dl、eGFR＜65.2ml/min/1.73m、血尿酸＞5.2mg/dl、结石体积＞1748mm、大通道大小、手术时间长、术中出血。AKI 患者的住院时间明显延长（3.2 天±0.45 与 2.1±0.42，p＜0.001）。
PNL 患者围手术期 AKI 的发生率为 13.9%。应识别和优化危险因素，并在 PNL 手术中精细操作，以降低 AKI 的风险。
