The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease.

Abstract

Objective: We evaluated the influence of percutaneous nephrolithotomy (PCNL) on the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Materials and Methods: Between September 2007 and April 2019, 280 patients with a preoperative eGFR level <90 mL/min/1.73 m2 and who underwent PCNL were retrospectively examined. The primary endpoint of this study was the effect of PCNL on eGFR levels in the 1st and 12th month after surgery in patients with CKD according to CKD stages. The secondary endpoint of this study was the identification of potential risk factors for deteriorated eGFRs. Results: The mean eGFR of patients was 48.7 ± 17 mL/min/1.73 m2 in the preoperative period, 54.7 ± 21 mL/min/1.73 m2 in the postoperative 1st month, and 59.1 ± 23.2 mL/min/1.73 m2 in the postoperative 12th month. It was determined that the increases in eGFRs in the postoperative 1st and 12th months were significant in all CKD stages (p < 0.005). Compared with preoperative values, the eGFR value was reduced in 61 (21.8%) patients in the 1st month and 49 (17.5%) patients in the 12th month. When these patients were compared with those in the stable eGFR and recovery group, multiaccess PCNL was an independent risk factor for renal function deterioration at the postoperative 1st and 12th month on multivariate analysis (odds ratios were 6.94 and 9.46, respectively). Conclusion: PCNL was found to have a positive effect on short- and long-term eGFRs in patients with CKD. However, multiaccess PCNL may have adversely affected eGFRs in both the short and long term.