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Percutaneous nephrolithotomy safe in patients with chronic kidney disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Percutaneous nephrolithotomy (PCNL) can be safely undertaken in patients with chronic kidney disease (CKD), researchers from Turkey report in the November 17th online issue of The Journal of Urology.

“Our study demonstrated that PCNL does not affect kidney function even in patients with limited kidney function,” Dr. Tolga Akman from Haseki Teaching and Research Hospital, Istanbul, Turkey told Reuters Health in an email. “Single tract as well as multitract PCNL can be safety performed in patients with CKD.”

Dr. Akman and colleagues investigated the long-term outcomes of 177 patients with CKD who underwent PCNL. One hundred forty-two had 1-access PCNL, and 35 underwent multitract PCNL.

Twenty-seven patients (15.2%) experienced 1 or more complications, including blood transfusions in 17 (9.6%), pelvicalyceal system perforation in 1 patient, urosepsis in 5 patients, transient fever in 6 patients, and acute renal failure in 3 patients.

After a mean follow-up of 43.4 months, renal function stage had improved in 52 patients (29.4%), was maintained in 96 patients (54.2%), and had worsened in 29 patients (16.4%).

Diabetes and the occurrence of complications were the only independent factors associated with kidney function deterioration. Hypertension did not appear to affect kidney function in these patients.

Most patients were stone-free at 3 months (142/177, 80.2%). Stones recurred during long-term follow-up in 36 of these patients (25.3%).

“Comprehensive metabolic evaluation, stone composition analysis, and metaphylaxis may aid in minimizing stone recurrence and the growth of residual stones after PCNL,” the researchers suggest.

“It is important to make efforts to minimize complications in this population, including the consideration of referral to surgeons with ample experience with PCNL,” they add.

Dr. Akman said PCNL could be standard treatment for “for larger than 2 cm renal stones and shock wave lithotripsy-resistant kidney stones in patients with chronic kidney disease.” [email interview]

“PCNL, RIRS (retrograde intrarenal surgery), and SWL (shock wave lithotripsy) are treatment alternatives for kidney stone in patients with CKD,” Dr. Akman added.

Reference:

Long-Term Outcomes of Percutaneous Nephrolithotomy in 177 Patients With Chronic Kidney Disease: A Single Center Experience

J Urol 2011;187:173-177.