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Clinical Considerations for Patients Experiencing Acute Kidney Injury Following Percutaneous Nephrolithotomy
Daniel A Reich1, Esra Adiyeke1,2,3, Tezcan Ozrazgat-Baslanti1,2,3
1University of Florida College of Medicine, Gainesville, FL 32610, USA.
Biomedicines
|June 28, 2023
Summary
Nearly 25% of patients undergoing percutaneous nephrolithotomy (PCNL) for kidney stones develop acute kidney injury (AKI). Risk factors include hypertension and certain medications, leading to worse outcomes.
Area of Science:
- Nephrology
- Urology
- Surgical Outcomes
Background:
- Acute kidney injury (AKI) is a frequent complication after urological surgery for nephrolithiasis.
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
- Limited data exists on postoperative AKI following PCNL.
Purpose of the Study:
- To determine the prevalence and severity of postoperative AKI in patients undergoing PCNL.
- To identify risk factors associated with AKI after PCNL.
- To understand the clinical outcomes of AKI in this patient population.
Main Methods:
- Retrospective analysis of 417 patient encounters undergoing PCNL between 2012 and 2019.
- Data collected on patient demographics, comorbidities, medications, and postoperative outcomes.
- Statistical analysis to identify risk factors and outcomes associated with AKI.
Main Results:
- The prevalence of postoperative AKI was 24.9% (104/417 patients).
- Of those with AKI, 17.3% (18/104) progressed to Stage 2 or higher.
- Significant risk factors for AKI included hypertension, peripheral vascular disease, chronic kidney disease, chronic anemia, and use of corticosteroids/antifungals.
- AKI patients experienced higher rates of cardiovascular complications, neurologic complications, sepsis, and prolonged ICU stays, with increased hospital and ICU length of stay.
Conclusions:
- Postoperative AKI is a significant concern following PCNL, affecting nearly a quarter of patients.
- Identifying and managing risk factors like hypertension and specific medications may mitigate AKI development.
- Further research is crucial to optimize patient care and reduce the adverse clinical outcomes associated with AKI post-PCNL.
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