MP30-06 ACUTE KIDNEY INJURY AFTER PERCUTANEOUS NEPHROLITHOTOMY FOR STONES IN A SOLITARY KIDNEY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-06 ACUTE KIDNEY INJURY AFTER PERCUTANEOUS NEPHROLITHOTOMY FOR STONES IN A SOLITARY KIDNEY Ahmed EL-Nahas, Diaa-Eldin Taha, Hussien Ali, Mohamed Zahran, Mahmoud Othman, Ahmed Harraz, Ahmed Mosbah, and Ahmed Shokeir Ahmed EL-NahasAhmed EL-Nahas More articles by this author , Diaa-Eldin TahaDiaa-Eldin Taha More articles by this author , Hussien AliHussien Ali More articles by this author , Mohamed ZahranMohamed Zahran More articles by this author , Mahmoud OthmanMahmoud Othman More articles by this author , Ahmed HarrazAhmed Harraz More articles by this author , Ahmed MosbahAhmed Mosbah More articles by this author , and Ahmed ShokeirAhmed Shokeir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.588AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate incidence, severity and outcome of acute kidney injury (AKI) that developed in patients with solitary kidney who underwent percutaneous nephrolithotomy (PNL). METHODS A prospective study protocol was approved by local ethical committee. The study included consecutive patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and September 2014. Patients with congenital renal anomalies, younger than 14 years or with estimated glomerular filtration rate (eGFR) <30 ml/min were excluded from the study. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-4 days and after 3 months. Preoperative and postoperative creatinine values were used for calculating eGFR using the Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI). The severity of AKI was determined with Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by calculation of eGFR. RESULTS The study included 87 patients (60% males) with mean age 50 +/- 11.7 years (range 15-74) and mean BMI 31+/- 6.6 (range 17.7-45.8). Other patients' charters are summarized in table 1. All PNL procedures were performed by or under direct supervision of experienced endourologists. Complications were reported for 36 patients (table 1). Only 3 of them required auxillary interventions in the form of angio-embolization for severe bleeding, ureteral stent for persistent urine leakage and intercostals chest tube for hydrothorax in 1 patient for each. AKI developed in 22 patients (25.3%, table 1). At 3 months follow-up, 17 patients (77.3%) completely recovered from AKI, 3 patients (13.6) showed partial recovery (follow-up eGFR was 30, 38, 41 ml/min respectively) and 2 patients (9%) developed stage 4 chronic kidney disease (follow-up eGFR was 15 and 23 ml/min respectively). CONCLUSIONS The incidence of acute kidney injury in 25% of patients after PNL for solitary kidney and the likelihood of renal function recovery in 90% after development of AKI are important in counselling patients with solitary kidney before doing PNL. Table 1. Characters of 87 patients who underwent PNL for calculi in solitary kidney: Number % Surgical history: No 45 62.1 Open surgery 18 20.7 PNL 15 17.2 Infected preoperative urine culture 28 32.2 Hydronephrosis: No 27 31 Mild 57 65.5 Moderate 3 3.4 Anaesthesia Spinal 66 76 General 21 24 Complications 36 41.4 Bleeding or Hematuria 16 18.4 Fever 14 16.1 Urinary leakage 5 5.7 Hydrothorax 1 1.1 Clavien Classification Grade 1 16 18.4 Grade 2 17 19.5 Grade 3a 3 3.4 Blood transfusion 18 20.7 Secondary procedures Second look PCNL 14 16.1 Flexible URS 1 1.4 Acute Kidney Injury (AKI) 22 25.3 Stages of AKI Stage I 15 17.2 Stage II 5 5.7 Stage III 2 2.3 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e349 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed EL-Nahas More articles by this author Diaa-Eldin Taha More articles by this author Hussien Ali More articles by this author Mohamed Zahran More articles by this author Mahmoud Othman More articles by this author Ahmed Harraz More articles by this author Ahmed Mosbah More articles by this author Ahmed Shokeir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...