Effect of endoscopic ureteral stone surgery on glomerular filtration rate in patients with renal impairment

Öz

Objective: We aimed to evaluate the estimated glomerular filtration rates (eGFR) change in upper ureteral stones before and after ureterorenoscopy (URS) or flexible ureterorenoscopy (fURS) in a patient group with preoperative eGFR level below 60 ml / min and the factors affecting it. Methods: Thirty-two patients who were scheduled for surgery due to upper ureteral stones and whose preoperative eGFR that calculated with the short MDRD formula, below 60 mL / min were included in the study. Factors that affect preoperative and postoperative eGFR changes of the patients were investigated by multiple linear regression analysis. Results: Patients with low renal reserve also showed a good improvement in renal function after treatment. Age, body mass index (BMI) and preoperative eGFR significantly affected postoperative eGFR (p <0.05). It was observed that postoperative eGFR was directly proportional to preoperative eGFR and inversely proportional to the other two parameters. Conclusion: With this study, it was shown for the first time in the literature that young age, high preoperative eGFR values and low BMI are good prognosis parameters in terms of postoperative eGFR increase in the patient population with low renal reserve.

Anahtar Kelimeler

• Endoscopic ureteral stone treatment
• Ureterorenoscopy
• Retrograde intrarenal surgery
• Glomerular filtration rate
• Low renal reserve
• Chronic renal failure

Böbrek fonksiyon bozukluğu olan hastalarda endoskopik üreter taşı cerrahisinin glomerüler filtrasyon hızı üzerine etkisi

Öz

Amaç: Ameliyat öncesi tahmini glomerüler filtrasyon oranları (eGFR) düzeyi 60 ml/dk’nın altında olan bir hasta grubunda üst üreter taşlarında üreterorenoskopi (URS) ya da fleksible üreterorenoskopi (fURS) öncesi ve sonrası eGFR değişimini ve buna etki eden faktörleri değerlendirmeyi amaçladık. Yöntem: Üst üreter taşı nedeniyle ameliyat planlanan ve kısa MDRD formülü ile hesaplanan ameliyat öncesi eGFR 60 ml/dk’nın altında olan 32 hasta çalışmaya dahil edildi. Hastaların ameliyat öncesi ve sonrası eGFR değişimlerine etki eden faktörler çoklu lineer regresyon analizi ile karşılaştırıldı. Bulgular: Düşük renal rezervli hastalar da tedavi sonrasında renal fonksiyonlar açısından iyi düzeyde bir iyileşme gösterdiler. Yaş, beden kitle indeksi (BKİ) ve preoperatif eGFR anlamlı düzeyde postoperatif eGFR’yi etkiliyordu (p<0.05). Postoperatif eGFR’nin preoperatif eGFR ile doğru, diğer iki parametre ile ise ters orantılı olduğu görüldü. Sonuç: Bu çalışma ile literatürde ilk defa renal rezervi düşük hasta popülasyonunda genç yaş, yüksek preoperatif eGFR değerleri ve düşük BKİ’nin postoperatif eGFR yükselmesi açısından iyi prognoz parametreleri olduğu gösterildi.

Anahtar Kelimeler

• Endoskopik üreter taşı tedavisi
• Üreterorenoskopi
• Retrograd intrarenal cerrahi
• Glomerüler filtrasyon hızı
• Düşük renal rezerv
• Kronik böbrek yetmezliği

Kaynakça

1. Knoll T, Alken P. Looking back on 50 years of stone treatment. Aktuelle Urol. 2019;50:157–65. https://doi.org/10.1055/a-0828-9936
2. Zhe M, Hang Z. Nephrolithiasis as a risk factor of chronic kidney disease: a meta-analysis of cohort studies with 4,770,691 participants. Urolithiasis. 2017;45:441–8. https://doi.org/10.1007/s00240-016-0938-x
3. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI Commentary KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Am J Kidney Dis. 2014;63:713–35. https://doi.org/10.1053/j.ajkd.2014.01.416
4. Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD. Practical Approach to Detection and Management of Chronic Kidney Disease for the Primary Care Clinician. Vol. 129, American Journal of Medicine. Elsevier Inc.; 2016 [cited 2021 Apr 18]. p. 153-162.e7. https://doi.org/10.1016/j.amjmed.2015.08.025
5. Huang Z, Fu F, Zhong Z, Zhang L, Xu R, Zhao X. Chinese minimally invasive percutaneous nephrolithotomy for intrarenal stones in patients with solitary kidney: A single-center experience. PLoS One. 2012;7. https://doi.org/10.1371/journal.pone.0040577
6. Nishi M, Matsumoto K, Fujita T, Iwamura M. Improvement in Renal Function and Symptoms of Patients Treated with Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction with Less Than 20% Split Renal Function. J Endourol. 2016;30:1214–8. https://doi.org/10.1089/end.2016.0553
7. Shi X, Peng Y, Li L, Li X, Wang Q, Zhang W, et al. Renal function changes after percutaneous nephrolithotomy in patients with renal calculi with a solitary kidney compared to bilateral kidneys. BJU Int. 2018;122:633–8. https://doi.org/10.1111/bju.14413
8. Saucier NA, Sinha MK, Liang K V, Krambeck AE, Weaver AL, Bergstralh EJ, et al. Risk Factors for CKD in Persons With Kidney Stones: A Case-Control Study in Olmsted County, Minnesota. Am J Kidney Dis. 2010;55:61–8. https://doi.org/10.1053/j.ajkd.2009.08.008

9. Teichman JM, Long RD, Hulbert JC. Long-term renal fate and prognosis after staghorn calculus management. J Urol. 1995;153:1403–7.
10. Sairam K, Scoffone CM, Alken P, Turna B, Sodha HS, Rioja J, et al. Percutaneous nephrolithotomy and chronic kidney disease: Results from the CROES PCNL global study. J Urol. 2012;188:1195–200. https://doi.org/10.1016/j.juro.2012.06.027
11. Cheung CM, Ponnusamy A, Anderton JG. Management of acute renal failure in the elderly patient: A clinician’s guide. Vol. 25, Drugs and Aging. 2008. p. 455–76. https://doi.org/10.2165/00002512-200825060-00002
12. Forni LG, Darmon M, Ostermann M, Oudemans-van Straaten HM, Pettilä V, Prowle JR, et al. Renal recovery after acute kidney injury. Intensive Care Med. 2017;43:855–66. https://doi.org/10.1007/s00134-017-4809-x
13. Chaabane W, Praddaude F, Buleon M, Jaafar A, Vallet M, Rischmann P, et al. Renal functional decline and glomerulotubular injury are arrested but not restored by release of unilateral ureteral obstruction (UUO). Am J Physiol - Ren Physiol. 2013;304. https://doi.org/10.1152/ajprenal.00425.2012
14. Demirtaş A, Caniklioğlu M, Kula M, Sofikerim M, Akınsal EC, Ergül MA, et al. Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99m-Dimercaptosuccinic Acid Scintigraphy. ISRN Urol. 2013;2013:1–5. https://doi.org/10.1155/2013/827121
15. Reeves T, Pietropaolo A, Somani BK. Ureteroscopy and Laser Stone Fragmentation Is Safe and Tends to Improve Renal Function in Patients with Chronic Kidney Disease: Prospective Outcomes with a Minimum Follow-Up of 6 Months. J Endourol. 2020;34:423–8. https://doi.org/10.1089/end.2019.0784
16. Desai MM, Grover R, Aron M, Ganpule A, Joshi SS, Desai MR, et al. Robotic flexible ureteroscopy for renal calculi: Initial clinical experience. J Urol. 2011;186:563–8. https://doi.org/10.1016/j.juro.2011.03.128
17. Castagnetti M, Novara G, Beniamin F, Vezzú B, Rigamonti W, Artibani W. Scintigraphic renal function after unilateral pyeloplasty in children: A systematic review. BJU Int. 2008;102:862–8. https://doi.org/10.1111/j.1464-410X.2008.07597.x
18. Tan BJ, Smith AD. Ureteropelvic junction obstruction repair: When, how, what? Curr Opin Urol. 2004;14:55–9. https://doi.org/10.1097/00042307-200403000-00002