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Baseline chronic kidney disease does not predict long-term renal functional decline after percutaneous nephrolithotomy

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Abstract

To compare renal functional outcomes in patients with and without chronic kidney disease (CKD) to identify predictors of change in renal function after percutaneous nephrolithotomy (PCNL). We reviewed patients who underwent PCNL by a single surgeon over 3.5 years. Patients’ pre- and post-operative Glomerular Filtration Rate (GFR) was calculated. Baseline GFR < 60 ml/min/1.73 m2 (stage ≥ 3 CKD) defined our CKD cohort. Patients’ baseline renal function, comorbidities, stone parameters, and intra-operative variables were analyzed to determine the relationship with post-operative renal function after PCNL by multivariate analysis. 202 patients were analyzed. Mean follow-up time was 16 months. At baseline, 163 (80.7%) patients were free of CKD and 39 (19.3%) had CKD. Patients without CKD had an overall decrease in GFR from 105.6 to 103.3 ml/min/1.73 m2 (p = 0.494). 14/163 (8.6%) non-CKD patients experienced a significant decline in renal function after PCNL; 7/163 (4.3%) developed de novo CKD and 7 had a ≥ 30% decline in GFR. Patients with CKD had an overall increase in mean GFR post-operatively, from 47.3 to 54.0 ml/min/m2 (p = 0.067). Two in this cohort (5.1%) experienced a > 30% decline in renal function post-operatively. Age, gender, African American race, presence of comorbidities and pre-operative CKD were not significant predictors of renal function post-operatively on multivariate analysis. PCNL in this cohort appears GFR neutral in the setting of baseline CKD. CKD was not predictive of renal functional decline after PCNL. Given that stone disease carries a high recurrence rate and that CKD is associated with stone formers, further investigation into predictors of renal function change after PCNL is warranted.

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Authors and Affiliations

  1. Department of Urology, Montefiore Medical Center, Bronx, USA

    Kara L. Watts, Abhishek Srivastava & Joshua M. Stern

  2. Albert Einstein College of Medicine, Bronx, USA

    Kara L. Watts, Wilson Lin, Daniel Schoenfeld & Joshua M. Stern

  3. Department of Medicine (Nephrology), Montefiore Medical Center, 1300 Morris Park Ave., Bronx, NY, 10461, USA

    Matthew Abramowitz

  4. 3400 Bainbridge Ave., Bronx, NY, 10467, USA

    Kara L. Watts & Abhishek Srivastava

  5. 1935 Eastchester Road #15F, Bronx, NY, 10461, USA

    Wilson Lin

  6. 1945 Eastchester Road # 5G, Bronx, NY, 10461, USA

    Daniel Schoenfeld

  7. 1250 Waters Place, Tower 1, Suite 706, Bronx, NY, 10461, USA

    Joshua M. Stern

Authors
  1. Kara L. Watts
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  2. Abhishek Srivastava
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  3. Wilson Lin
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  4. Daniel Schoenfeld
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Correspondence to Kara L. Watts.

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Watts, K.L., Srivastava, A., Lin, W. et al. Baseline chronic kidney disease does not predict long-term renal functional decline after percutaneous nephrolithotomy. Urolithiasis 47, 449–453 (2019). https://doi.org/10.1007/s00240-019-01113-5

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  • DOI: https://doi.org/10.1007/s00240-019-01113-5

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