Mp22-03 acute Kidney Injury and Percutaneous Nephrolithotomy

Fu, Juan; Calle, Juan; Elía, M.; Wright, Harlan I.; Li, Ina; Monga, Manoj

doi:10.1097/ju.0000000000000855.03

Cited by 2 publications

(5 citation statements)

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“…Incidence of postoperative AKI for major open urological procedures varies from 6.7% to 38.2% [5][6][7][8][9]. Surprisingly, very few studies report complications of PNL and AKI [12][13][14]. This may be because impairment of renal function in the absence of significant perioperative complications appears to be minimal, transient and focal.…”

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

Pillai

Kriplani

Chawla

et al. 2021

JCM

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Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender, body mass index (BMI), comorbidities (hypertension, diabetes mellitus), and drug history—particularly angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers and beta blockers. Laboratory data included serial serum creatinine measured pre- and postoperation (12, 24, and 48 h), hemoglobin (Hb), total leucocyte count (TLC), Prothrombin time (PT), serum uric acid and urine culture. Stone factors were assessed by noncontrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden, location and Hounsfield values. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Postoperative complications were documented using the modified Clavien–Dindo grading system and patients with postoperative AKI were followed up with serial creatinine measurements up to 1 year. Among the 509 patients analyzed, 47 (9.23%) developed postoperative AKI. Older patients, with associated hypertension and diabetes mellitus, those receiving ACE inhibitors and with lower preoperative hemoglobin and higher serum uric acid, had higher incidence of AKI. Higher stone volume and density, staghorn stones, multiple punctures and longer operative time were significantly associated with postoperative AKI. Patients with AKI had an increased length of hospital stay and 17% patients progressed to chronic kidney disease (CKD). Cut-off values for patient age (39.5 years), serum uric acid (4.05 mg/dL) and stone volume (673.06 mm3) were assessed by receiver operating characteristic (ROC) curve analysis. Highlighting the strong predictors of post-PNL AKI allows early identification, proper counseling and postoperative planning and management in an attempt to avoid further insult to the kidney.

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Section: Discussionmentioning

confidence: 99%

“…Reduced plasma volume, cardiac and neuronal changes, leading to intraoperative hypotension in elderly patients, are described as causing postoperative AKI [13,18]. Autonomic neuropathy due to diabetes is known to cause perioperative hemodynamic changes [19].…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

Pillai

Kriplani

Chawla

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…The prevalence of postoperative AKI following significant urological surgeries ranges from 6.7 to 38.2% [ 5 , 9 – 11 ]. Few studies report AKI after PNL [ 12 , 16 , 17 ]; this may be explained as impairment of renal function without substantial perioperative problems seems minor and may pass unnoticed. AKI may increase postoperative morbidity, mortality, need for postoperative ICU admission, and demand for renal replacement treatment, so every attempt to accurately define the predictors of AKI should be made.…”

Section: Discussionmentioning

confidence: 99%

“…This research found that low preoperative haemoglobin and high serum creatinine levels were predictive factors for postoperative AKI, especially in individuals with preoperative Hb < 10.8 g/dl and individuals who had a preoperative creatinine > 1.41 mg/dl. Research by Fulla et al, Sunil et al, and Fayad et al defined the same factors as predictors of AKI [ 16 , 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stone factors such as large stones and stones with high density increase the complexity and the operative time of the procedure, with the increased possibility of perioperative blood loss and infectious complications leading to a higher risk of AKI. Multiple previous studies defined these stone factors as predictors of AKI [ 16 , 17 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of acute kidney injury after percutaneous nephrolithotomy in adult patients: prospective observational study

Hasan,

Riyad,

Ahmed

2024

Int Urol Nephrol

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Purpose To assess the frequency and the predictive factors of Acute Kidney injury (AKI) in patients undergoing percutaneous nephrolithotomy (PNL). Methods A prospective observational work. Demographic, preoperative laboratory data, stone characteristics, and intraoperative and postoperative data were gathered. Perioperative AKI had been defined as an elevation in serum creatinine by ≥ 0.3 mg/dl within 48 h, or ≥ 1.5 times baseline, or urine volume less than 0.5 ml/ kg/hour for 6 hours. A multivariate logistic regression analysis was performed to determine the predictive factors of AKI. ROC curves were utilized to determine the cutoff values of the risk variables. P-values were deemed statistically significant when they were less than 0.05. Results A total of 418 participants had been involved. The frequency of AKI was 13.9, and 17.2% of patients with AKI developed CKD. The risk factors were age > 46.5 years, smoking, BMI > 28.5 kg/m2, hypertension, diabetes, utilization of angiotensin-converting enzyme inhibitors (ACEI), haemoglobin < 10.8 gm/dl, baseline creatinine > 1.41 mg/dl, eGFR < 65.2 ml/min./1.73 m2, serum uric acid > 5.2 mg/dl, stone volume > 1748 mm3, large tract size, long operative time, and intra-operative bleeding. Patients with AKI had a notably extended duration of hospitalization (3.2 days ± 0.45 vs 2.1 ± 0.42, p < 0.001). Conclusions Perioperative AKI occurred in 13.9% of individuals undergoing PNL. Identification and optimization of the risk factors and meticulous technique during PNL procedures should be attempted to decrease the risk of AKI.

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Mp22-03 acute Kidney Injury and Percutaneous Nephrolithotomy

Cited by 2 publications

References 0 publications

Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

Predictors of acute kidney injury after percutaneous nephrolithotomy in adult patients: prospective observational study

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