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Does percutaneous nephrolithotomy and its outcomes have an impact on renal function? Quantitative analysis using SPECT-CT DMSA

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Abstract

To assess the functional effects of percutaneous nephrolithotomy (PCNL) and its outcomes in the operated kidney, we prospectively studied 30 consecutive cases undergoing PCNL. Kidney function was evaluated preoperatively and 3 months after surgery with serum creatinine, glomerular filtration rate (GFR), and with 99mTc-DMSA SPECT-CT scans to determine the differential renal function (DRF). PCNL effects in the operated kidney DRF were considered globally (DRFPLANAR, DRFSPECT) and in the region of percutaneous access (DRFACCESS). PCNL functional impact was also assessed depending on its outcomes, namely success (stone-free status) and the development of perioperative complications. PCNL has rendered 73 % of the cases completely stone free with a 33 % complication rate. After PCNL, serum creatinine and GFR did not change significantly, whereas DRFPLANAR and DRFSPECT dropped 1.2 % (p = 0.014) and 1.0 % (p = 0.041), respectively. The highest decrease was observed in DRFACCESS (1.8 %, p = 0.012). Stone-free status after PCNL did not show any impact on kidney function. Conversely, cases that suffered from a complication showed impairment in serum creatinine (0.1 mg/dL, p = 0.028), in GFR (11.1 mL/min, p = 0.036) as well as in DRFPLANAR (2.7 %, p = 0.018), DRFSPECT (2.2 %, p = 0.023) and DRFACCESS (2.7 %, p = 0.049). We conclude that PCNL has a minimal impact on global kidney function, which is mainly located in the region of percutaneous access. The advent of perioperative complications increased PCNL functional damage, whereas the stone-free status did not show any meaningful effect.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CT:

Computerized tomography

DMSA:

Dimercaptosuccinic acid

DRFACCESS :

Differential renal function assessed by SPECT-CT in the region of percutaneous access

DRFPLANAR :

Differential renal function assessed by planar scintigraphy

DRFSPECT :

Differential renal function assessed by SPECT

DTPA:

Diethylenetriaminepentaacetic acid

GFR:

Glomerular filtration rate

MDRD:

Modification of diet in renal disease

PCNL:

Percutaneous nephrolithotomy

ROI:

Region of interest

SPECT:

Single-photon emission computed tomography

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

Written informed consent was obtained for this investigation, which was done in accordance with the Principles of the Declaration of Helsinki and approved by the Ethical Committee of Clinical Investigation in Galicia, Spain.

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Authors and Affiliations

  1. Urology Department, University Hospital Complex of Santiago de Compostela, Travesía Choupana s/n, 15706, Santiago de Compostela, Spain

    Daniel Pérez-Fentes & Camilo García

  2. Surgery Department, University of Santiago de Compostela, Santiago de Compostela, Spain

    Daniel Pérez-Fentes & Camilo García

  3. Nuclear Medicine Department. IDIS, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain

    Julia Cortés & Álvaro Ruibal

  4. Department of Radiology and Physical Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain

    Julia Cortés & Álvaro Ruibal

  5. Clinical Epidemiology Unit, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain

    Francisco Gude

  6. Tejerina Foundation, Madrid, Spain

    Álvaro Ruibal

  7. University of Santiago de Compostela Fundación Ramón Domínguez. Nuclear Medicine Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain

    Pablo Aguiar

Authors
  1. Daniel Pérez-Fentes
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  2. Julia Cortés
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  3. Francisco Gude
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  4. Camilo García
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  5. Álvaro Ruibal
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  6. Pablo Aguiar
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Correspondence to Daniel Pérez-Fentes.

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Pérez-Fentes, D., Cortés, J., Gude, F. et al. Does percutaneous nephrolithotomy and its outcomes have an impact on renal function? Quantitative analysis using SPECT-CT DMSA. Urolithiasis 42, 461–467 (2014). https://doi.org/10.1007/s00240-014-0693-9

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  • DOI: https://doi.org/10.1007/s00240-014-0693-9

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