Predictive factors for functional improvement and assessment of outcomes in CKD patients after PCNL.

Abstract

Introduction: Patients with urinary stone disease may present with CKD. The incidence of developing end stage renal disease (ESRD) in patients with renal calculi is 0.2%-3.2%. In the present study we aim to discuss outcomes of PCNL in CKD patients.

Materials and methods: This was a prospective observational study done, from January 2023 to March 2024. Data of 96 CKD patients with renal stones who underwent standard PCNL were recorded. Patients were followed up with urinalysis, serum creatinine and ultrasound KUB. Preoperative eGFR were compared with eGFR 36 months follow up. Patients were divided into two groups. Group 1- improved and group 2- stable or worsened disease since the final follow up visit.

Observations and results: After PCNL renal function improvement was seen in 52 (54%) patients that is, Group I & in 44 (46%) patients it was stable or declined that is, Group II. In Group I, mean preoperative eGFR was 41.13 ± 14.23 ml/min/m² which improved to 46.91 ± 12.14. In Group II mean preoperative eGFR was 37.14 ± 12.32 which declined to 33.17 ± 12.57. The statistically significant factor decreasing the efficacy of PCNL in CKD patients were presence of co morbidities (Hypertension, DM; p = 0.007), staghorn stones (p = 0.001), history of previous renal surgery (p = 0.001), operation time > 100 min (p < 0.0001), post PCNL stone free status(p < 0.0001), and Complications(p = 0.03). After 6 months follow up 8 patients in Group I shifted from CKD stage 4 to CKD stage 3 and four patients in group II shifted from CKD stage 3 to CKD stage 4.

Conclusion: Factors like presence of comorbidities, staghorn calculus, previous surgery operative time and post operative complications affects improvement of renal function in CKD patients after stone clearance.