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Journal of Research in Medical Sciences... 2024The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
BACKGROUND
The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure.
MATERIALS AND METHODS
From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI.
RESULTS
The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age ( = 0.887), gender ( = 0.566), and underlying comorbidities including diabetes mellitus ( = 0.577) and hypertension ( = 0.383). The mean body mass index (BMI) ( < 0.001) and both frequency and severity of hydronephrosis ( < 0.001) were significantly different. A higher mean PCNL duration ( < 0.001), period of hospitalization ( < 0.001), and blood loss volume ( < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure ( < 0.001). A lower preoperative hemoglobin level was observed in the AKI group ( < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, < 0.001) and higher Hounsfield units ( < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), ( < 0.001).
CONCLUSION
The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).
PubMed: 38808219
DOI: 10.4103/jrms.jrms_317_23 -
Clinical Nephrology. Case Studies 2023We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of...
PURPOSE
We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition.
OBSERVATIONS
We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis.
CONCLUSION AND IMPORTANCE
These cases highlight the need for judicious clinical suspicion of calciphylaxis in patients with kidney failure, presenting with microvascular ischemic ophthalmic pathology such as AION or CRAO. Confirmation with temporal artery biopsy is essential to direct targeted individualized multi-disciplinary treatment of calciphylaxis and avoid unnecessary steroid exposure in cases masquerading as giant cell arteritis (GCA).
PubMed: 38169875
DOI: 10.5414/CNCS111088 -
World Journal of Urology Mar 2024The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing...
BACKGROUND
The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis.
PURPOSE
To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones.
METHODS
A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion.
RESULTS
The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document.
CONCLUSION
A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.
Topics: Humans; Staghorn Calculi; Kidney Calculi; Urolithiasis
PubMed: 38526675
DOI: 10.1007/s00345-024-04816-6 -
BMJ Case Reports Sep 2023A man in his 50s presented with right flank pain and intermittent haematuria for 15 days. He was evaluated and diagnosed to have bilateral staghorn renal calculi with...
A man in his 50s presented with right flank pain and intermittent haematuria for 15 days. He was evaluated and diagnosed to have bilateral staghorn renal calculi with left poorly functioning kidney. He underwent right kidney stone clearance followed by laparoscopic left simple nephrectomy. Postoperatively, he developed recurrent urinary tract infections. On evaluation, non-contrast CT of the abdomen revealed calculus in left ureteral stump and he was diagnosed to have ureteric stump syndrome. He underwent ureteroscopy which revealed multiple stump calculi and complete stone clearance was achieved. Currently, the patient is asymptomatic and doing well after a follow-up of 1 year.
Topics: Male; Humans; Ureter; Kidney; Ureteroscopy; Abdominal Cavity; Kidney Calculi; Staghorn Calculi; Syndrome
PubMed: 37723093
DOI: 10.1136/bcr-2023-255126 -
World Journal of Clinical Cases Mar 2024It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent...
BACKGROUND
It is possible that this condition will lead to urosepsis and progressive deterioration of renal function in the absence of surgical intervention. Several recent clinical studies have shown that multi-tract percutaneous nephrolithotomy (M-PCNL) has a similar stone free rate (SFR) as standard percutaneous nephrolithotomy (S-PCNL). As a result, M-PCNL was also recommended as a treatment option for staghorn calculi.
AIM
To examine the perioperative and long-term results of ultrasonography-guided single- and M-PCNL.
METHODS
This was a retrospective cohort study. Between March 2021 and January 2022, the urology department of our hospital selected patients for the treatment of staghorn calculi using percutaneous nephrolithotomy. The primary outcomes were complication rate and SFR, and the characteristics of patients, operative parameters, laboratory measurements were also collected.
RESULTS
In total, 345 patients were enrolled in the study (186 in the S-PCNL group and 159 in the M-PCNL group). The SFR in the M-PCNL group was significantly higher than that in the S-PCNL group ( = 0.033). Moreover, the incidence rates of hydrothorax ( = 0.03) and postoperative infection ( = 0.012) were higher in the M-PCNL group than in the S-PCNL group. Logistic regression analysis demonstrated that post-operative white blood cell count (OR = 2.57, 95%CI: 1.90-3.47, < 0.001) and stone size (OR = 1.59, 95%CI: 1.27-2.00, < 0.001) were associated with a higher overall complication rate in the S-PCNL group. Body mass index (OR = 1.22, 95%CI: 1.06-1.40, = 0.004) and stone size (OR = 1.70, 95%CI: 1.35-2.15, < 0.001) were associated with increased overall complications in the M-PCNL group.
CONCLUSION
Multiple access tracts can facilitate higher SFR while slightly increasing the incidence of acceptable complications.
PubMed: 38524503
DOI: 10.12998/wjcc.v12.i7.1243 -
Current Opinion in Urology Jul 2023To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal... (Review)
Review
PURPOSE OF REVIEW
To systematically review the evolution of techniques, technology, clinical utility, limitations and possible future applications of endoscopic combined intrarenal surgery (ECIRS) for ureteral and kidney stones.
RECENT FINDINGS
The literature search was performed on 18th January 2023 using PubMed, EMBASE and Scopus. 35 studies were included. Among them, six were reviews. Since its introduction in 2008, ECIRS has evolved and improved. ECIRS can be performed in different patient position, such as modified supine Valdivia position by Galdakao, prone position with split-leg and supine position with good outcomes. Instrument miniaturization has also been introduced in ECIRS making it doable in an ambulatory setting. ECIRS showed shorter operative time, lower complication rate, and retreatment compared with conventional PCNL. Operative outcomes of mini-ECIRS are better than mini-PCNL alone. ECIRS also showed good outcomes in impacted upper ureteric stones. Recently, some studies have explored the robotic-assisted kidney puncture in ECIRS that avoided multitrack surgery, especially in anomalous kidney and staghorn stones.
SUMMARY
ECIRS is ready for primetime in endourology and can be considered the next gold-standard for a personalized stone approach in complex kidney stones.
Topics: Humans; Kidney Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Ureteral Calculi
PubMed: 37158647
DOI: 10.1097/MOU.0000000000001106 -
Cureus May 2024This study reviews the challenges and management strategies for complex renal stones in Africa. Historically viewed as infection or struvite stones, recent studies... (Review)
Review
This study reviews the challenges and management strategies for complex renal stones in Africa. Historically viewed as infection or struvite stones, recent studies highlight diverse compositions of staghorn stones. These complex stones pose significant risks, including recurrent urinary tract infections and renal impairment. In the past, conservative management of staghorn stones was associated with high morbidity; thus, surgical intervention was necessary for complete eradication. While percutaneous nephrolithotomy (PCNL) remains the standard, it carries notable risks, leading to a shift towards minimally invasive techniques. This study reviews challenges and management practices for complex renal stones and staghorn calculi in African countries, evaluating stone-free rates and associated complications. A scoping review of the literature, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, was performed. A systematic search was conducted in PubMed, African Journal Online (AJOL) and Google Scholar, yielding 1,101 articles, but only 11 articles satisfied the inclusion criteria. The study included 1,513 patients with 1,582 renal units, predominantly male (67.2%) with an average age of 40.7 years. Percutaneous nephrolithotomy (PCNL) was the primary treatment for the majority (71.3%), followed by open surgery (21.9%), laparoscopic surgery (4.1%), and retrograde intrarenal surgery (RIRS) (2.7%). The stone clearance rates for PCNL, open surgery, laparoscopic pyelolithotomy, and RIRS were 82.8%, 83.7%, 100%, and 92.8%, respectively. Stone sizes ranged between 22 and 80 mm, with 66% being staghorn stones. Complication rates were highest for open surgery (30.8%) and lowest for RIRS (4.7%). Despite PCNL being the global standard, African studies still indicate a high reliance on open surgery, likely due to healthcare infrastructure, resource availability and socioeconomic factors. Enhancing access to urological care and addressing healthcare disparities are imperative for improving staghorn stone management in Africa.
PubMed: 38919234
DOI: 10.7759/cureus.61134 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Staghorn Calculi; Candida albicans; Abscess; Kidney Diseases; Urinary Tract Infections
PubMed: 37851830
DOI: 10.1590/0037-8682-0421-2023 -
Frontiers in Endocrinology 2023A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation...
BACKGROUND
A model to predict preoperative outcomes after percutaneous nephrolithotomy (PCNL) with renal staghorn stones is developed to be an essential preoperative consultation tool.
OBJECTIVE
In this study, we constructed a predictive model for one-time stone clearance after PCNL for renal staghorn calculi, so as to predict the stone clearance rate of patients in one operation, and provide a reference direction for patients and clinicians.
METHODS
According to the 175 patients with renal staghorn stones undergoing PCNL at two centers, preoperative/postoperative variables were collected. After identifying characteristic variables using PCA analysis to avoid overfitting. A predictive model was developed for preoperative outcomes after PCNL in patients with renal staghorn stones. In addition, we repeatedly cross-validated their model's predictive efficacy and clinical application using data from two different centers.
RESULTS
The study included 175 patients from two centers treated with PCNL. We used a training set and an external validation set. Radionics characteristics, deep migration learning, clinical characteristics, and DTL+Rad-signature were successfully constructed using machine learning based on patients' pre/postoperative imaging characteristics and clinical variables using minimum absolute shrinkage and selection operator algorithms. In this study, DTL-Rad signal was found to be the outstanding predictor of stone clearance in patients with renal deer antler-like stones treated by PCNL. The DTL+Rad signature showed good discriminatory ability in both the training and external validation groups with AUC values of 0.871 (95% CI, 0.800-0.942) and 0.744 (95% CI, 0.617-0.871). The decision curve demonstrated the radiographic model's clinical utility and illustrated specificities of 0.935 and 0.806, respectively.
CONCLUSION
We found a prediction model combining imaging characteristics, neural networks, and clinical characteristics can be used as an effective preoperative prediction method.
Topics: Animals; Humans; Nephrolithotomy, Percutaneous; Artificial Intelligence; Nephrostomy, Percutaneous; Deer; Prognosis; Kidney Calculi
PubMed: 37780621
DOI: 10.3389/fendo.2023.1184608