Cormio Angelo, Castellani Daniele, De Palma Domenico, Fiorella Ruggiero, Ratnayake Runeel, Lotito Michele, Albino Giuseppe, Falagario Ugo Giovanni, Busetto Gian Maria, Bettocchi Carlo, Carrieri Giuseppe, Cormio Luigi
Urology Unit Azienda Ospedaliero-Universitaria delle Marche Ancona Italy.
Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia University of Foggia Foggia Italy.
BJUI Compass. 2025 Sep 7;6(9):e70084. doi: 10.1002/bco2.70084. eCollection 2025 Sep.
To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.
A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.
Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33-4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07-3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04-11.58, p = 0.04).
The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.
探讨微创经皮肾镜取石术（mini-PCNL）后急性肾损伤（AKI）的发生率、危险因素及临床后果，尤其关注其与术后感染性并发症的关联。
对2020年2月至2025年4月期间接受mini-PCNL（22F）的496例成年患者进行回顾性分析。根据KDIGO标准，AKI定义为术后72小时内血清肌酐升高≥1.5倍或绝对值增加≥0.3mg/dl。患者被分为AKI组和非AKI组。进行多变量逻辑回归分析以确定AKI发生和感染性并发症的预测因素。
所有病例均采用脊髓麻醉进行手术。45例患者（9.1%）发生AKI。两组间中位手术时间无差异（52.5对55.0分钟，p = 0.33）。两组在性别分布、中位年龄、体重指数、基线血清肌酐、合并症发生率和结石特征方面无差异。AKI患者术后总体并发症发生率显著更高（24.4%对7.1%，p < 0.001），住院时间更长（4天对3天，p < 0.001）。AKI组感染性并发症明显更频繁，降钙素原中位水平更高（0.21对0.06ng/ml，p = 0.03）。AKI组1例患者死于败血症。多变量分析确定既往PCNL（OR 2.51，95%CI 1.33 - 4.72，p < 0.01）和更高的基线血清肌酐（OR 2.00，95%CI 1.07 - 3.73，p = 0.03）为AKI的独立预测因素。AKI是感染性并发症的唯一独立预测因素（OR 3.47，95%CI 1.04 - 11.58，p = 0.04）。
AKI与感染性并发症之间的强关联，包括败血症导致的潜在死亡，凸显了这种报告不足的并发症的临床意义。对于mini-PCNL后发生AKI的患者，加强围手术期监测和积极处理感染性并发症是必要的。
