Percutaneous Nephrolithotomy in Patients with Chronic Kidney Disease: A Systematic Review

Abstract

<b><i>Background:</i></b> Renal calculi in chronic kidney disease (CKD) are not uncommon. Percutaneous nephrolithotomy (PCNL) is a standard treatment for large renal calculi. PCNL in CKD has been a subject of debate as it may improve the renal function with stone clearance but may be associated with an increased complication rate. Studying the impact of PCNL in CKD patients is of utmost significance. <b><i>Objective:</i></b> The aim of the study was to evaluate the efficacy and safety of PCNL in patients with renal insufficiency in order to provide clinicians expected outcomes to effectively counsel patients. <b><i>Methods:</i></b> We performed a systematic review of clinical trials reporting the outcomes of PCNL in CKD patients. The search was performed in MEDLINE, EMBASE, Cochrane Library, CINAHL, Google Scholar, and Web of Science. All studies with a minimum of 15 patients carried out in the last 20 years were selected. A total of 13 studies involving 2,192 patients were included for final analysis. The pre-operative and post-operative renal function was compared. Post-procedure complications were analysed. <b><i>Evidence Analysis:</i></b> The majority of patients in all studies except one had either improvement or stabilization in renal function. The complication rate was 31.9%, which was more than that in patients with normal renal function. <b><i>Conclusion:</i></b> Our review suggested that the majority of the patients of renal calculus with renal insufficiency are benefitted with PCNL in improving or preserving the renal function. But the post-operative complications are more in CKD and increases as the severity of renal insufficiency increases.

Comparison of mini-percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for patients with kidney stones and renal insufficiency: A retrospective study

“…The patients were further divided into CKD3 and CKD4 subgroups, and the differences in postoperative complication rates were comparable. The overall post-PCNL complication rate in our study was 32.8%, which is in accordance with the results of Mehra K [4], who reported that the overall complication rate of PCNL in patients with renal insu ciency was 31.9%, and all the complications were manageable.…”

“…Previous studies have shown that renal dysfunction is associated with a greater risk of perioperative blood transfusion, which is attributed to pathophysiologic characteristics such as platelet-vessel wall dysfunction and poorer coagulation function in patients with renal insu ciency [20]. The blood transfusion rate of PCNL in patients with chronic kidney disease was 12.8%, which was higher than that in the cohort of patients with normal renal function, in whom it is reported to be approximately 7% [4,21]. In our study, SPCNL clearly had a disadvantage in terms of transfusion, which is similar to the ndings of the prospective study reported by Güler et al (MPCNL: 2.0%, SPCNL: 15.2%, P = 0.018) [22].…”

“…The e cacy and safety of MPCNL and SPCNL in patients with normal renal function have been widely recognized, but there is no de nite conclusion as to which approach is most appropriate [16,17]. Previously, studies suggested that PCNL improved or preserved the renal function of patients with kidney stones and renal insu ciency, but the complication rates were greater than those in patients with normal renal function [4].…”

“…In patients with kidney stones and renal insu ciency, PCNL is challenging because it may not improve renal function or is associated with more signi cant complications. Evidence has shown that the post-PCNL complication rate is greater in patients with renal insu ciency than in patients with normal renal function, and the overall complication rates in patients with abnormal and normal renal function are 31.9% and 20.53%, respectively [4,24]. However, studies comparing the complication rate between MPCNL and SPCNL in patients with renal insu ciency are limited.…”

“…Factors contributing to renal insu ciency include urinary tract obstruction, recurrent urinary tract infections, surgical interventions, and combined medical conditions such as diabetes mellitus [1][2][3]. In such patients, it is crucial to preserve as much renal function as possible and avoid serious complications in addition to ensuring a good SFR [4]. PCNL is the rst-line treatment for kidney calculi measuring > 2 cm in diameter [5].…”