Bazal Böbrek Fonksiyon Rezervine Göre Perkütan Nefrolitotominin Böbrek Fonksiyonları Üzerine Erken ve Geç Etkileri

Year 2022, Volume: 17 Issue: 1, 115 - 120, 21.03.2022

Murat Şahan Mehmet Erhan Aydın , Serkan Yarımoğlu , Ömer Koraş , Salih Polat , Fatih Gokalp , Serdar Çelik

https://doi.org/10.17517/ksutfd.861872

Abstract

Amaç: Bu çalışmada, perkütan nefrolitotominin böbrek fonksiyonları üzerindeki erken ve geç etkisini preoperatif glomerular filtrasyon hızı düzeylerine göre araştırmayı amaçladık.
Gereç ve Yöntemler: Ocak 2012 ve Kasım 2016 arasında perkütan nefrolitotomi uygulanan 351 hasta çalışmaya dahil edildi. Preoperatif glomerular filtrasyon hızına göre hastalar üç gruba ayrıldı: Grup-1 glomerular filtrasyon hızı > 90, Grup-2 glomerular filtrasyon hızı = 60-90, Grup-3 glomerular filtrasyon hızı <60 seviyelerindeki hastalardan oluşmaktaydı. Glomerular filtrasyon hızı ölçümleri ameliyat öncesi, postoperatif 1. gün ve 3. ayda yapıldı.
Bulgular: Postoperatif 1. günde, ortalama glomerular filtrasyon hızı grup 1 ve grup 2'de anlamlı olarak azalmışken, grup 3'te anlamlı olarak azalmamıştır. 3. aydaki ortalama glomerular filtrasyon hızı, grup 1 ve grup 2'de preoperatif düzeylere göre düşük saptandı, ancak bu istatistiksel olarak anlamlı değildi. Bununla birlikte, grup 3'ün ortalama glomerular filtrasyon hızı preoperatif düzeylere göre istatistiksel olarak anlamlı derecede arttı.
Sonuç: Glomerular filtrasyon hızı, böbrek fonksiyonlarının iyi bir göstergesidir ve perkütan nefrolitotomi prosedüründen önemli ölçüde etkilenir. Böbrek travma prosedürü nedeniyle perkütan nefrolitotomi sonrası böbrek fonksiyonu azalmış olsa da, böbrek taşı nedeniyle ameliyat olan hastalarda postoperatif 3. ayda böbrek fonksiyonu iyiye gider. Bu nedenle perkütan nefrolitotomi, böbrek taşına bağlı preoperatif glomerular filtrasyon hızı <60 olan hastalarda böbrek fonksiyonlarını önemli ölçüde iyileştirdi.

Keywords

Perkutan nefrolitotomi, Böbrek taşı, Glomeruler filtrasyon hızı, Kreatinin klirensi

Early and Late Effects of Percutaneous Nephrolithotomy on Renal Functions According to Basal Renal Function Reserv

Abstract

Objective: In this study, we aimed to investigate the early and late effect of percutaneous nephrolithotomy on renal function based on preoperative glomerular filtration rate levels.
Material and Method: Between January 2012 and November 2016, 351 patients who underwent percutaneous nephrolithotomy were included. According to the preoperative glomerular filtration rate, patients were divided into three groups: group 1 was consists of glomerular filtration rate >90 levels; group 2 was consists of glomerular filtration rate levels between 60-90; group 3 was consists of glomerular filtration rate <60 levels. Glomerular filtration rate measure¬ments were performed preoperatively, at post-operative 1st day and 3rd month.
Results: On postoperative 1st day, mean glomerular filtration rate was significantly decreased in group 1 and group 2, non-significantly decreased in group 3. At 3rd month, the mean glomerular filtration rate was again decreased compared to preoperative levels in group 1 and group 2 but this time it was statistically non-significant. However, mean glomerular filtration rate of group 3 was statistically significantly increased compared to preoperative levels.
Conclusions: Estimated glomerular filtration rate, as a better indicator of renal function, is significantly affected by the percutaneous nephrolithotomy procedure. Although, firstly renal function decreased after percutaneous nephrolithotomy because of the renal trauma procedure, kidney function is better at postoperative 3rd month because of the disappearance of kidney stone . So percutaneous nephrolithotomy was significantly improved the renal functions in patients with preoperative glomerular filtration rate < 60 due to renal stone.

Keywords

Percutaneous nephrolithotomy, Renal stone, Glomerular filtration rate, Creatinine clearance

References

• 1. Indridason OS, Birgisson S, Edvardsson VO, Sigvaldason H, Sigfusson N, Palsson R. Epidemiology of kidney stones in Iceland: a population-based study. Scand J Urol Nephrol 2006;40:215-220.
• 2. Gambaro G, Favaro S, D'Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001;37:233-243.
• 3. Méndez Probst CE, Denstedt JD, Razvi H. Preoperative indications for percutaneous nephrolithotripsy in 2009. J Endourol 2009;23:1557-1561.
• 4. de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. CROES PCNL Study Group. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25:11-17.
• 5. Handa RK, Matlaga BR, Connors BA, Ying J, Paterson RF, Kuo RL, et al. Acute effects of percutaneous tract dilation on renal function and structure. J Endourol. 2006;20:1030-1040.
• 6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
• 7. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.
• 8. Lin J, Knight EL, Hogan ML, Singh AK. Comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol. 2003;14:2573-80. Erratum in: J Am Soc Nephrol. 2005;16:2814.
• 9. Webb DR, Fitzpatrick JM. Percutaneous nephrolithotripsy: a functional and morphological study. J Urol 1985;134:587–591.
• 10. Nazaroglu H, Akay AF, Bükte Y, Sahin H, Akkus Z, Bilici A. Effects of extracorporeal shock‑wave lithotripsy on intrarenal resistive index. Scand J Urol Nephrol. 2003;37:408‑412.
• 11. DiBona GF, Kopp UC. Neural control of renal function. Physiol Rev 1997;77:75‑197.
• 12. Connors BA, Evan AP, Willis LR, Simon JR, Fineberg NS, Lifshitz DA, et al. Renal nerves mediate changes in contralateral renal blood flow after extracorporeal shockwave lithotripsy. Nephron Physiol. 2003;95:67-75.
• 13. Atici S, Zeren S, Aribogan A. Hormonal and hemodynamic changes during percutaneous nephrolithotomy. Int Urol Nephrol 2001;32:311‑314.
• 14. Saxby MF. Effects of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy on renal function and prostaglandin excretion. Scand J Urol Nephrol 1997;31:141-144.
• 15. Urivetsky M, Motola J, King L, Smith AD. Impact of percutaneous renal stone removal on renal function: assessment by urinary lysozyme activity. Urology 1989;33:305–308.
• 16. Nouralizadeh A, Sichani MM, Kashi AH. Impacts of percutaneous nephrolithotomy on the estimated glomerular filtration rate during the first few days after surgery. Urol Res 2011;39:129-133.
• 17. Handa RK, Willis LR, Connors BA, Gao S, Evan AP, Kim SC, et al. Time-course for recovery of renal function after unilateral (single-tract) percutaneous access in the pig. J Endourol. 2010;24:283-288.
• 18. Gupta M, Bolton DM, Gupta PN, Stoller ML. Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol 1994;152:1086–1090.
• 19. Bilen CY, Inci K, Kocak B, Tan B, Sarikaya S, Sahin A. Impact of percutaneous nephrolithotomy on estimated glomerular filtrationn rate in patients with chronic kidney disease. J Endourol 2008;22:895–900.
• 20. Kukreja R, Desai M, Patel SH, Desai MR.Nephrolithiasis associated with renal insufficiency: factors predicting outcome. J Endourol 2003;17:875–879.
• 21. Watts KL, Srivastava A, Lin W, Schoenfeld D, Abramowitz M, Stern JM. Baseline chronic kidney disease does not predict long-term renal functional decline after percutaneous nephrolithotomy. Urolithiasis 2019;47:449-453
• 22. Etemadian M, Maghsoudi R, Shadpour P, Ghasemi H, Shati M. Outcomes of tubeless percutaneous nephrolithotomy in patients with chronic renal insufficiency. Iran J Kidney Dis 2012;6:216-218.