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Perkütan nefrolitotomide tekli ve çoklu girişlerin glomerüler filtrasyon hizi üzerine olan etkilerinin karşılaştırılması

Yıl 2016, Cilt: 8 Sayı: 4, 195 - 199, 01.12.2016
https://doi.org/10.21601/ortadogutipdergisi.271539

Öz

Amaç:
Bu çalışmada böbrek taşı nedeniyle perkütan nefrolitotomi (PNL) yapılan
hastalarda giriş sayısı ile glomeruler filtrasyon hızındaki (GFR) değişimler
arasındaki ilişki değerlendirilmiştir.

Gereç ve Yöntem:
Ocak 2012-Eylül 2015
arasında PNL uygulanan 564 hasta çalışmaya dahil edildi. Hastalar tıbbi
hikayeleri, laboratuvar ve görüntüleme yöntemleriyle değerlendirildiler. Tüm
hastalara operasyon sırasında standard PNL tekniği uygulandı. Yapılan giriş
sayısına gore hastalar iki gruba ayrıldılar: tekli giriş yapılanlar grup-1’e,
çoklu giriş yapılanlar grup 2’ye dahil edildiler. GFR’yi belirlemek için
Cockcroft-Gault formulü ile tahmini kreatinin klerensi hesaplandı. GFR
ölçümleri preoperatif olarak ve postoperatif 1. ve 3. aylarda yapıldı.

Bulgular: Ortalama yaşlar grup-1 ve grup-2 için, sırasıyla, 48.5±12.7 ve 47.6±12.9 yıl idi. Ortalama taş boyutu grup-1’de
501.88±517.61 mm2, grup-2’de 622.36±607.16 mm2 (p=0.151)
idi. Ortalama preoperatif GFR değerleri 100.36±32.08 ml/dk ile 101.49±36.65 ml/dk
idi ve aradaki fark anlamlı değildi (p=0.803). Postoperatif 1. ve 3. aylardaki
ortalam GFR’ler grup-1 ve 2 için sırasıyla, 91.13±31.10 ml/dk karşılık
91.63±33.74 ml/dk ve 97.32±30.89 ml/dk karşılık 96.44±30.09  ml/dk idi. Bununla birlikte aradaki farklar
anlamlı değildi (p=0.836 ve p=0.483). Postoperatif 3. aydaki GFR değişimi
grup-1’ de grup 2’ye kıyasla daha düşüktü (-3.04±20.37 ml/dk karşılık
-5.05±22.95 ml/dk) ve aradaki fark anlamlı değildi (p=0.483).







Sonuç: PNL operayonu sonrası GFR düşmektedir. Tekli ve çoklu
girişlerin böbrek fonksiyonları üzerine olan etkisi benzerdir. Hastaların
taşsızlık oranlarını artırmak için, böbrek fonksiyonlarında herhangi bir
bozulma olmaksızın, çoklu girişler yapılabilir.



Kaynakça

  • 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;40:215-20.
  • Gambaro G, Favaro S, D'Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001;37:233-43.
  • Méndez Probst CE, Denstedt JD, Razvi H. Preoperative indications for percutaneous nephrolithotripsy in 2009. J Endourol 2009;23:1557-61.
  • de la Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011;25:11-7.
  • Chatham JR, Dykes TE, Kennon WG, Schwartz BF. Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography. Urology 2002;59:522-5.
  • Pérez-Fentes D, Cortés J, Gude F, García C, Ruibal A, Aguiar P. Does percutaneous nephrolithotomy and its outcomes have an impact on renal function? Quantitative analysis using SPECT-CT DMSA. Urolithiasis 2014;42:461-7.
  • Lin J, Knight EL, Hogan ML, Singh AK. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003;14:2573-80.
  • Fayad AS, Elsheikh MG, Mosharafa A, et al. Effect of multiple access tracts during percutaneous nephrolithotomy on renal function: evaluation of risk factors for renal function deterioration. J Endourol 2014;28:775-9.
  • Handa RK, Evan AP, Willis LR, et al. Renal functional effects of multiple-tract percutaneous access. J Endourol 2009;23:1951-6
  • Hegarty NJ, Desai MM.Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-60.
  • 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;39:129-33.
  • Handa RK, Willis LR, Connors BA, et al. Time-course for recovery of renal function after unilateral (single-tract) percutaneous access in the pig. J Endourol 2010;24:283-8.
  • Webb DR, Fitzpatrick JM. Percutaneous nephrolithotripsy: a functional and morphological study. J Urol 1985;134:587-91.
  • Levey AS, Inker LA, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis 2014;63:820-34.
  • Gorbachinsky I, Wood K, Colaco M, et al. Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter? J Urol 2016;196:131-6.
  • Hallan SI, Orth SR. The conundrum of chronic kidney disease classification and end-stage renal risk prediction in the elderly--what is the right approach? Nephron Clin Pract 2010;116:307-16.

Comparing the effects of single and multiple accesses on the glomerular filtration rates in percutaneous nephrolithotomy

Yıl 2016, Cilt: 8 Sayı: 4, 195 - 199, 01.12.2016
https://doi.org/10.21601/ortadogutipdergisi.271539

Öz

Aim:
In this study, we assessed
the relationship between number of access and changes on glomerular filtration
rate (GFR) in patients who underwent percutaneous nephrolithotomy (PNL) for
kidney stones.

Material
and Method
: Between
January 2012 and September 2015, 564 patients who underwent PCNL were included
in this study. Patients were evaluated by medical history, laboratory and
imaging methods. Standard PCNL technique was applied to all the patients during
the operation. According to the access number, patients were divided into two
groups: Single access was performed in Group-1 and multiple accesses were
performed in Group-2. To determine the GFR, estimated creatinine clearance was
calculated by the Cockcroft-Gault Formula. GFR measurements were performed
preoperatively and on the post-operative 1st and 3rd months.

Results:
The
mean ages in group-1 and group-2 were 48.5±12.7 and 47.6±12.9 years,
respectively (p=0.613). The mean stone size was 501.88±517.61 mm2 in
group-1 and 622.36±607.16 mm2 in group-2 (p=0.151). Mean
preoperative GFR levels were 100.36±32.08 ml/min and 101.49±36.65 ml/min, and
the difference was not statistically significant (p=0.803). On the
postoperative 1st and the 3rd months, mean GFRs were 91.13±31.10 ml/min vs
91.63±33.74 ml/min and 97.32±30.89 ml/min vs 96.44±30.09 ml/min in group-1 and group-2,
respectively. However, the differences were not statistically significant
(p=0.836 and p=0.483). Although the GFR changes on the postoperative 3rd month
were lower in group-1 when compared to group-2 (-3.04±20.37 ml/min
vs-5.05±22.95 ml/min), the difference was not statistically significant
(p=0.483).







Conclusion: After
PNL surgery, GFR decreases. Effects of single and multiple accesses on the
kidney function are similar. In order to increase the stone-free rates of the
patients, multiple accesses can be performed without any impairment on renal
functions.

Kaynakça

  • 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;40:215-20.
  • Gambaro G, Favaro S, D'Angelo A. Risk for renal failure in nephrolithiasis. Am J Kidney Dis 2001;37:233-43.
  • Méndez Probst CE, Denstedt JD, Razvi H. Preoperative indications for percutaneous nephrolithotripsy in 2009. J Endourol 2009;23:1557-61.
  • de la Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011;25:11-7.
  • Chatham JR, Dykes TE, Kennon WG, Schwartz BF. Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography. Urology 2002;59:522-5.
  • Pérez-Fentes D, Cortés J, Gude F, García C, Ruibal A, Aguiar P. Does percutaneous nephrolithotomy and its outcomes have an impact on renal function? Quantitative analysis using SPECT-CT DMSA. Urolithiasis 2014;42:461-7.
  • Lin J, Knight EL, Hogan ML, Singh AK. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003;14:2573-80.
  • Fayad AS, Elsheikh MG, Mosharafa A, et al. Effect of multiple access tracts during percutaneous nephrolithotomy on renal function: evaluation of risk factors for renal function deterioration. J Endourol 2014;28:775-9.
  • Handa RK, Evan AP, Willis LR, et al. Renal functional effects of multiple-tract percutaneous access. J Endourol 2009;23:1951-6
  • Hegarty NJ, Desai MM.Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-60.
  • 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;39:129-33.
  • Handa RK, Willis LR, Connors BA, et al. Time-course for recovery of renal function after unilateral (single-tract) percutaneous access in the pig. J Endourol 2010;24:283-8.
  • Webb DR, Fitzpatrick JM. Percutaneous nephrolithotripsy: a functional and morphological study. J Urol 1985;134:587-91.
  • Levey AS, Inker LA, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis 2014;63:820-34.
  • Gorbachinsky I, Wood K, Colaco M, et al. Evaluation of Renal Function after Percutaneous Nephrolithotomy-Does the Number of Percutaneous Access Tracts Matter? J Urol 2016;196:131-6.
  • Hallan SI, Orth SR. The conundrum of chronic kidney disease classification and end-stage renal risk prediction in the elderly--what is the right approach? Nephron Clin Pract 2010;116:307-16.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Deniz Bolat

Mehmet Erhan Aydın Bu kişi benim

Serkan Yarımoğlu Bu kişi benim

Tansu Değirmenci Bu kişi benim

İbrahim Halil Bozkurt Bu kişi benim

Özgü Aydoğdu Bu kişi benim

Tarık Yonguç Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 8 Sayı: 4

Kaynak Göster

Vancouver Bolat D, Aydın ME, Yarımoğlu S, Değirmenci T, Bozkurt İH, Aydoğdu Ö, Yonguç T. Perkütan nefrolitotomide tekli ve çoklu girişlerin glomerüler filtrasyon hizi üzerine olan etkilerinin karşılaştırılması. otd. 2016;8(4):195-9.

e-ISSN: 2548-0251

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