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Published on: July 19, 2018
Acute effects of percutaneous tract dilation on renal function and structure
Rajash K Handa1, Brian R Matlaga, Bret A Connors
1Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. rhanda@iupui.edu
Percutaneous nephrostomy (PCN) procedures, using Amplatz dilators or Nephromax balloons, significantly reduce kidney function. Both animal and human studies confirm an acute decline in renal function after PCN for kidney stone removal.
Area of Science:
- Nephrology
- Urology
- Surgical Innovation
Background:
- Percutaneous nephrolithotomy (PCNL) is a standard procedure for removing large kidney stones.
- Tract dilation is a critical step in PCNL, but its acute effects on renal function are not well understood.
- Current knowledge gaps exist regarding the immediate impact of tract dilation on kidney hemodynamics and excretion.
Purpose of the Study:
- To investigate the acute effects of percutaneous nephrostomy (PCN) tract dilation on renal function.
- To compare the impact of Amplatz dilators versus Nephromax balloon inflation on renal hemodynamics and excretory function.
- To assess the changes in renal function in both animal models and human patients undergoing PCNL.
Main Methods:
- Comparative study in female pigs using sequential Amplatz dilators or Nephromax balloon inflation for PCN, with a control group.
- Sequential measurements of renal hemodynamic and excretory function up to 5 hours post-procedure.
- Retrospective analysis of renal function (serum creatinine) in adult patients undergoing PCNL.
Main Results:
- Both Amplatz and Nephromax dilation caused significant reductions in glomerular filtration rate (GFR) by ~50% and renal plasma flow (RPF) by ~60% in pigs.
- Urinary sodium excretion (U(Na)V) decreased by ~80% in treated kidneys, while control kidneys showed a ~50% decline.
- Human PCNL patients showed a significant increase in serum creatinine of 0.14 mg/dL at 1 day post-procedure.
Conclusions:
- Percutaneous nephrostomy (PCN) procedures are associated with a significant acute decline in renal function.
- Both rigid dilation and balloon dilation methods impact renal hemodynamics and excretory function.
- Further research may be needed to mitigate these acute renal functional changes during PCNL.
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