Risk factors for deterioration of renal function after percutaneous nephrolithotomy in solitary kidney patients with staghorn calculi

Jiahao Wang; Yunjin Bai; Shan Yin; Jianwei Cui; Yin Tang; Zhenghao Wang; Bo Chen; Hong Li; Wuran Wei; Jia Wang

doi:10.21037/tau-20-916

Risk factors for deterioration of renal function after percutaneous nephrolithotomy in solitary kidney patients with staghorn calculi

Transl Androl Urol. 2020 Oct;9(5):2022-2030. doi: 10.21037/tau-20-916.

Authors

Jiahao Wang¹, Yunjin Bai¹, Shan Yin¹, Jianwei Cui¹, Yin Tang¹, Zhenghao Wang¹, Bo Chen¹, Hong Li¹, Wuran Wei¹, Jia Wang¹

Affiliation

¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.

Abstract

Background: Nowadays, it has not been reported in detail which factors have adverse effects on renal function after PNCL surgery in solitary kidney patients with staghorn calculi. To evaluate the risk factors that deteriorate the renal function in solitary kidney patients with staghorn calculi after percutaneous nephrolithotomy (PCNL).

Methods: A retrospective study was performed on solitary kidney patients with staghorn calculi between March 2014 and Jun 2019. Renal function-related indexes were collected pre-operatively, and at 1 and 6 months post-operatively. These pre- and post-operative indexes were compared to study the risk factors on renal function.

Results: Totally 71 solitary kidney patients with staghorn calculi were included with a male-to-female ratio of 53:18 and mean age of 54.3±10.2 years old. The mean pre-operative estimated glomerular filtration rate (eGFR) and serum creatinine were 55.1±18.9 mL/min/1.73 m² and 130.9±41.0 µmol/L, respectively. The mean diameter of largest stones was 5.0±1.7 cm, and the stone-free rate was 71.8%. Univariate analysis showed urinary tract infection (UTI) was a significant risk factor for deteriorating renal function after PCNL. At 1 to 6 months after surgery, renal function deteriorated by both UTI and combined diseases. The surgical side at the right kidney, mild hydronephrosis, and surgical time without 20 min or beyond 40 min can deteriorate renal function. Multivariate analysis demonstrated UTI was the main factor leading to deteriorated renal function with increasing serum creatinine and declining eGFR.

Conclusions: Preoperative UTI can deteriorate the renal function at 1 month after PCNL, and diabetes can deteriorate the postoperative renal function at 6 months after PCNL. Controlled perioperative UTI, diabetes and factors play a crucial role in protecting renal function after PCNL for solitary kidney patients with staghorn calculi.

Keywords: Percutaneous nephrolithotomy (PCNL); renal function; risk factors; solitary kidney; staghorn calculi.