Changes in renal function following per cutaneous nephro lithotomy in chronic kidney disease patients with symptomatic renal calculus disease

Abstract

Introduction: Preserving renal function is the Achilles heel in the management of chronic kidney disease (CKD) patient due to the influence of multiple factors in its progression both reversible and irreversible. Renal calcular disease has both cause-and-effect relationship with CKD. Symptomatic renal calcular disease in a CKD patient gives an opportunity to preserve renal function to a variable extent depending on the stage of CKD as well as other comorbities of the patient. Percutaneous nephro lithotripsy is one of the best modalities to relieve obstructed renal tracts and its beneficial effects are established in patients with normal renal function however its efficacy in preserving renal function in CKD patients is less well studied, hence we have undertaken this study. Materials and Methods: A prospective observational study was done to study the changes in renal function as assessed by eGFR and Sr creatinine following Per Cutaneous Nephro Lithotripsy at 0-, 1-, and 3-months interval in CKD patients with symptomatic renal calculus disease. Repeated measure ANNOVA test followed by multiple comparison test was applied to study the outcome. P < 0.05 was considered statistically significant. Results: A total of 60 patients were studied, 80% were male and 20% female. Mean age of the patients in our study was 50.66 ± 13.82 years. out of 60 patients, 36.7% patients had diabetes mellitus, 55% patients had hypertension, and 11.6% had coronary heart disease. The most common presenting symptom was pain 70%, followed by recurrent fever. Most of the patients belong to CKD stage IV (30%). 65% showed improvement in renal function, 25% has stabilization in renal function, and only 10% showed deterioration of renal function. The complication rate was 23%. Discussion and Conclusion: In our study male to female patients' ratio was 4:1 and the most common presenting symptom is flank pain (70%). The renal function improved or stabilized in 90% of patients which was high compared to other studies and deteriorated in 10% patients. PCNL has favourable outcomes in CKD patients with improvement in eGFR, good clearance rate, and low secondary procedure rates. CKD Patients with age above 60 years and having both Diabetes Mellitus and Hypertension may not show significant improvement in Serum creatinine and eGFR. In conclusion, CKD patients can be benefitted by PCNL with good improvement of eGFR and acceptable morbidity when aggressive preoperative stabilization is being done.