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Long-term effects of anatrophic nephrolithotomy on selective renal function
Ahmed R El-Nahas1, Amr A Elsawy2, Ahmed Abdelhalim2
1Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. ar_el_nahas@yahoo.com.
Urolithiasis
|April 28, 2018
Summary
Anatrophic nephrolithotomy (ANL) can lead to significant long-term decline in kidney function. Minimizing cold ischemia time to under 50 minutes is crucial for preserving renal function after ANL.
Area of Science:
- Urology
- Nephrology
- Surgical Outcomes
Background:
- Anatrophic nephrolithotomy (ANL) is a surgical procedure for large kidney stones.
- Long-term effects of ANL on selective renal function require further investigation.
Purpose of the Study:
- To evaluate long-term changes in selective renal function after ANL.
- To identify risk factors associated with renal function deterioration post-ANL.
Main Methods:
- Retrospective study of 50 patients undergoing ANL (1995-2016).
- Radio-isotopic renal scans (99mTc MAG3) assessed glomerular filtration rate (GFR%) pre- and post-operatively (≥1 year follow-up).
- Statistical analyses, including univariate and multivariate, and ROC curve analysis were used to identify risk factors.
Main Results:
- Mean GFR% significantly decreased from 52.7% to 45.4% (P < 0.001) over a median follow-up of 2.7 years.
- Renal function deterioration (>5% GFR% decrease) occurred in 42% of kidneys.
- Cold ischemia time >50 minutes was identified as an independent risk factor for GFR% deterioration (RR 3.986, P=0.039).
Conclusions:
- ANL can result in significant long-term decline in selective renal function.
- Cold ischemia time is a critical modifiable factor; limiting it below 50 minutes may preserve renal function.
- ANL should be reserved for select patients, with efforts to minimize surgical ischemia time.
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