The impact of percutaneous nephrolithotomy in patients with chronic kidney disease

The impact of percutaneous nephrolithotomy (PCNL) in chronic kidney disease (CKD) patients was retrospectively analyzed in this study. We analyzed the factors that can impair renal function and predict the need for renal replacement therapy (RRT) after PCNL.

Ninety-one chronic kidney patients with a mean age of 52.5 +/- 13 involving 117 renal units underwent PCNL in our institution for 5 years. A mean of 1.6 +/- 1.1 tracks and 1.3 +/- 0.6 sittings per renal unit was required for PCNL. The estimated glomerular filtration rate (eGFR) pre-PCNL (postdrainage), peak eGFR on follow-up, and eGFR at last follow-up were recorded. The CKD stage pre-PCNL was compared with the CKD stage at last follow-up.

Complete clearance, auxiliary procedure, and complication rates were 83.7%, 2.5%, and 17.1%, respectively. The mean eGFR pre-PCNL and peak eGFR at follow-up were 32.1 +/- 12.8 and 43.3 +/- 18.8 mL/minute/1.73 m(2), respectively (p < 0.0001). At a mean follow-up of 329 +/- 540 days, deterioration with up-migration of CKD stage was seen in 12 patients (13.2%). Eight patients (8.8%) required RRT in the form of either maintenance hemodialysis or renal transplantation. Postoperative bleeding complication requiring blood transfusions was seen in seven (5.9%) and two (1.7%) of the renal units subsequently required super selective angioembolization. There were two mortalities in the postoperative period. Postoperative complications and peak eGFR (less than 30 mL/minute/1.73 m(2)) at follow-up are two factors that predict renal deterioration and RRT. Renal parenchymal thickness (<8 mm) also predicts the need for RRT.

PCNL has a favorable impact in CKD patients with good clearance rates and good renal functional outcome. PCNL in this high-risk CKD population is to be done with care and full understanding of its complications.