Percutaneous nephrolithotomy for renal stones in chronic kidney disease and poorly functioning kidney: a prospective study

Abstract

Introduction Removal of stone in patients with coexistent renal insufficiency improves the function of the kidney in most of the cases. Percutaneous nephrolithotomy (PCNL) is considered a suitable minimally invasive treatment option in these patients with minimum morbidity and mortality. Patients and methods This was a prospective study conducted in Assiut University Hospital, Egypt, from March 2015 to March 2018 to assess the efficacy and safety of PCNL in patients with chronic kidney disease (CKD) and patients with unilateral poorly functioning kidney (UPFK). The authors recruited patients aged greater than or equal to 18 years, with renal stone with either CKD or UPFK. All patients were managed with PCNL. Primary outcomes were stone clearance and complications rates. Secondary outcomes were serum creatinine and estimated glomerular filtration rate. Data collected were analyzed using Statistical Package for the Social Sciences 20 software. P value was considered significant if less than or equal to 0.05. Results At early follow-up (1 month postoperatively), the stone clearance rate was 54.8% (23 patients) and at late follow-up (3 months postoperatively), it was 61.9% (26 patients). Intraoperative complications occurred in six (14.3%) patients; intraoperative bleeding managed by blood transfusion (four patients), and pelvicalyceal system perforation was managed by double-J stent insertion (two patients). Postoperative complications occurred in 17 (40.5%) patients, mainly low-grade fever in eight (19%) patients. Conclusion PCNL has favorable outcomes in patients with CKD and patients with UPFK regarding complete stone clearance rates. Safety of PCNL and postoperative renal function improvement remain questionable for further studies.