确认输尿管镜检查和激光碎石术后急性肾损伤：来自三级医疗转诊中心的结果。

Acknowledging acute kidney disease following ureteroscopy and laser lithotripsy: results from a tertiary care referral center.

机构信息

Division of Experimental Oncology/Unit of Urology, Università Vita-Salute San Raffaele, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.

GRC No 20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.

出版信息

Int Urol Nephrol. 2024 Dec;56(12):3905-3911. doi: 10.1007/s11255-024-04155-w. Epub 2024 Jul 15.

DOI:10.1007/s11255-024-04155-w

PMID:39008224

Abstract

BACKGROUND

Acute kidney disease (AKD) is a recently described syndrome consisting of kidney function abnormalities lasting less than 3 months. Little is known regarding AKD following ureteroscopy (URS) and laser lithotripsy.

OBJECTIVE

To evaluate the occurrence and evolution of AKD in stone patients treated with URS.

MATERIALS AND METHODS

Data from 284 patients treated with URS for urinary stones were retrospectively analyzed. According to the KDIGO 2020 criteria, AKD was defined as postoperative acute kidney injury (AKI) occurrence, estimated glomerular filtration rate (eGFR) decrease ≥ 35%, or serum creatinine (SCr) increase ≥ 50%. AKI was defined as SCr increase ≥ 0.3 mg/dL or ≥ 50%. AKD evolution was evaluated 60 days post-URS. Data were analyzed using descriptive statistics. Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients' characteristics and perioperative data with the occurrence of AKD.

RESULTS

Overall, postoperative AKD occurred in 32 (11.3%) patients. Recovery from AKD was found in 26 (82%) patients and persistent AKD occurred in 6 (18%) patients. At UVA, age at surgery (p = 0.05), baseline SCr (p = 0.02), baseline CKD category (p = 0.006), Charlson comorbidity index (p = 0.01), operative time (p = 0.04) and postoperative complications (< 0.001) were associated with AKD. At MVA, CKD category (OR 2.99, 95% CI = 1.4-6.3; p = 0.004), operative time (OR 1.01, 95% CI = 1.001-1.018; p = 0.023) and postoperative complications (OR 3.5, 95% CI = 1.46-8.49; p = 0.005) were independent predictors of AKD.

CONCLUSIONS

AKD is a frequent complication in patients treated with URS. Moreover, AKD persists in a non-neglectable percentage of patients at medium-term follow-up. Therefore, nephrological assessment should be considered, especially in high-risk patients. Current findings should be considered for the peri-operative management of stone patients.

摘要

背景

急性肾损伤（AKD）是一种新描述的综合征，其特征为持续时间少于 3 个月的肾功能异常。对于输尿管镜检查（URS）和激光碎石术后 AKD 的了解甚少。

目的

评估接受 URS 治疗的结石患者 AKD 的发生和演变。

材料和方法

回顾性分析了 284 例接受 URS 治疗尿路结石的患者的数据。根据 KDIGO 2020 标准，将 AKD 定义为术后急性肾损伤（AKI）的发生、估计肾小球滤过率（eGFR）下降≥35%或血清肌酐（SCr）升高≥50%。AKI 定义为 SCr 升高≥0.3mg/dL 或≥50%。术后 60 天评估 AKD 的演变。使用描述性统计数据进行数据分析。单变量（UVA）和多变量（MVA）逻辑回归分析测试了患者特征和围手术期数据与 AKD 发生的相关性。

结果

总体而言，术后 AKD 发生在 32 例（11.3%）患者中。26 例（82%）患者的 AKD 恢复，6 例（18%）患者的 AKD 持续存在。在 UVA 中，手术时的年龄（p=0.05）、基线 SCr（p=0.02）、基线 CKD 分期（p=0.006）、Charlson 合并症指数（p=0.01）、手术时间（p=0.04）和术后并发症（p<0.001）与 AKD 相关。在 MVA 中，CKD 分期（OR 2.99，95%CI=1.4-6.3；p=0.004）、手术时间（OR 1.01，95%CI=1.001-1.018；p=0.023）和术后并发症（OR 3.5，95%CI=1.46-8.49；p=0.005）是 AKD 的独立预测因子。