MP79-03 PERCUTANEOUS NEPHROLITHOTOMY IN KIDNEYS WITH IMPAIRED RENAL FUNCTION: RECOVERABILITY ASSESSMENT USING DIURETIC SCINTIGRAPHY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP79)1 Apr 2019MP79-03 PERCUTANEOUS NEPHROLITHOTOMY IN KIDNEYS WITH IMPAIRED RENAL FUNCTION: RECOVERABILITY ASSESSMENT USING DIURETIC SCINTIGRAPHY Ahmed Harraz*, Hossam Nabeeh, Mohamed Elbaset, Diaa-Eldin Taha, Islam Fakhreldin, Ahmed El-Nahas, and Yasser Osman Ahmed Harraz*Ahmed Harraz* More articles by this author , Hossam NabeehHossam Nabeeh More articles by this author , Mohamed ElbasetMohamed Elbaset More articles by this author , Diaa-Eldin TahaDiaa-Eldin Taha More articles by this author , Islam FakhreldinIslam Fakhreldin More articles by this author , Ahmed El-NahasAhmed El-Nahas More articles by this author , and Yasser OsmanYasser Osman More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557355.22025.fbAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: To determine at which limit percutaneous nephrolithotomy (PNL) is valuable in kidneys with impaired function. METHODS: A prospective study was performed for patients undergoing PNL from February 2013 to May 2016. The study received our institutional review board approval. Inclusion criteria included stone harboring-kidneys with impaired function defined by the presence of moderate to marked hydronephrosis, parenchymal thinning and/or increased echogenicity. Differential renal function (DRF) was determined using Tc99-MAG3 scintigraphy at baseline and 3-6 months post-operatively. At the same time points, total estimated glomerular filtration rate (eGFR) was measured by the Modification of Diet in Renal Disease (MDRD) equation. Both measures were used to calculate the individual eGFR (i-eGFR) for the PNL-operated kidney. The primary outcome of the study was a deterioration of i-eGFR by ≥ 15% after PNL. Receiver Operating Characteristic (ROC) curve analysis was performed to determine i-eGFR cut-off value significantly associated with the outcome. Predictors of the outcome were determined using the appropriate statistical tests. RESULTS: In 115 analyzed kidneys, renal function decreased by ≥ 15% in 57 (49.6%) patients while remained stationary and improved in 49 (42.6%) and 9 (7.8%), respectively. The cohort was divided into two groups based on baseline i-eGFR of ≤ 15 ml/min/1.73 m2 as indicated by ROC curve (AUC: 0.6; P=0.02). In the group with baseline i-eGFR ≤ 15 ml/min/1.73 m2 35 (61.4%) kidneys showed post-PNL deterioration compared to 22 (37.9%) with baseline i-eGFR > 15 (P=0.01). Multivariate analysis revealed that lower i-eGFR (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.2-6.1; P=0.01) and previous open surgery (OR: 2.7; 95%CI: 1.1-7; P=0.03) were independent predictors of postoperative decline in renal function. CONCLUSIONS: PNL performed in kidneys with impaired function ≤ 15 ml/min/1.7 m2 and/or previously operated by open surgery were more likely to experience postoperative renal function deterioration and therefore the benefit of surgery should be weighed against the outcome. Source of Funding: None Mansoura, Egypt; Kafr El-Sheikh, Egypt; Mansoura, Egypt; Kafr El-Sheikh, Egypt; Mansoura, Egypt© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1152-e1152 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Harraz* More articles by this author Hossam Nabeeh More articles by this author Mohamed Elbaset More articles by this author Diaa-Eldin Taha More articles by this author Islam Fakhreldin More articles by this author Ahmed El-Nahas More articles by this author Yasser Osman More articles by this author Expand All Advertisement PDF downloadLoading ...