Changes in estimated glomerular filtration rate after percutaneous nephrolithotomy in patients with stage 2-4 chronic...

Percutaneous nephrolithotomy (PCNL) is the gold standard technique used for the treatment of large renal stones ≥ 2 cm. However, in patients with chronic kidney disease (CKD), the effect of PCNL remains underreported. We aimed to prospectively evaluate the changes in estimated glomerular filtration rate (eGFR) after PCNL in patients with stage 2-4 CKD.

This prospective study included patients with stage 2-4 CKD who underwent PCNL in the period from December 2020 to December 2023. eGFR was measured using the Cockroft-Gault formula preoperatively and 3 months postoperatively. Patients were classified as either improved/stable or deteriorated. Perioperative complications and stone-free rate (SFR) were also evaluated.

The study included 50 patients (male/female = 33/17) with CKD who underwent PCNL. The mean operative time was 84.8 ± 27.4 min. A total number of 49 complications were reported in 21 patients. At a follow-up of 3 months, eGFR was improved/stable in 40 (80%) patients, and it deteriorated in 10 (20%) patients. The SFR was 76% at 3 months postoperatively. Factors that significantly affected the eGFR were bleeding, access number, incidence of perioperative complications, stone burden, and operative time.

PCNL is an effective and safe treatment option for patients with stage 2-4 CKD with renal stones ≥2 cm. It is advisable to avoid long operative time, excessive bleeding, and multiple accesses as possible in these patients to minimize the risk of renal function deterioration.