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Percutaneous nephrolithotomy in patients with chronic kidney disease

Volume 9, Issue 1

Original Article / Published: November 2021


K. Petkova, S.Hristoforov, P. Petrov, O. Gatsev, I. Saltirov

Clinic of Endourology and SWL Department of Urology and Nephrology Military Medical Academy of Sofia


Introduction and objective: Urolithiasis can impair renal function by obstruction, infection, its association with comorbidities, high recurrence rate and need for multiple surgical interventions. Treatment of patients with chronic kidney disease (CKD) may be challenging due to the increased risk for intra- and postoperative complications, higher ASA score and association with comorbidities. The objective of this study is to compare the preoperative characteristics, efficacy and safety of PCNL in patients with normal or mildly impaired renal function and patients with chronic kidney disease. Materials and methods: Prospectively collected data on 1656 PCNL procedures, performed in the Department of Urology and Nephrology at Military Medical Academy, Sofia, Bulgaria between 2011 and 2021 was analyzed. Patients were divided in 2 groups: Group 1 (1244 patients with normal or mildly impaired renal function, eGFR > 60 mL/min/1.73 m2) and Group 2 (412 patients with moderately impaired renal function and end stage renal disease, eGFR < 60 mL/min/1.73 m2) Results: Patients with CKD were more likely to be older, be female, with higher incidence of comorbidities and higher preoperative ASA score, higher rate of recurrent stones, solitary kidney and staghorn stones. PCNL efficacy after single procedure and at 3rd postoperative month was lower for CKD patients (respectively 79,6% vs 83,4%, р=0.086, and 85,9% vs 90,1%, р=0.018). There were no statistically significant differences in postoperative hemoglobin drop (14,0±10,2 vs 14,2±10,4, р=0.772) and overall complications rate (14,6% vs 12,1%, р=0.793) between the two groups. Conclusion: The results of this study suggest that PCNL is an effective and safe procedure in patients with chronic kidney disease. Although, CKD patients had larger and more complex stones, higher comorbidity rate, and higher incidence of recurrent stones and infection, these factors had no negative impact on PCNL outcomes compared to patients with normal or mildly impaired renal function.


  1. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003 May;63(5):1817-23. doi: 10.1046/ j.1523-1755.2003.00917.x. PMID: 12675858.
  2. Hesse A, Brändle E, Wilbert D, Köhrmann KU, Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003 Dec;44(6):709-13. doi: 10.1016/s0302-2838(03)00415-9. PMID: 14644124.
  3. Chuang TF, Hung HC, Li SF, Lee MW, Pai JY, Hung CT. Risk of chronic kidney disease in patients with kidney stones-a nationwide cohort study. BMC Nephrol. 2020 Jul 22;21(1):292. doi: 10.1186/s12882-020-01950-2. PMID: 32698782; PMCID: PMC7376912.
  4. Kummer AE, Grams M, Lutsey P, Chen Y, Matsushita K, Köttgen A, Folsom AR, Coresh J. Nephrolithiasis as a Risk Factor for CKD: The Atherosclerosis Risk in Communities Study. Clin J Am Soc Nephrol. 2015 Nov 6;10(11):2023-9. doi: 10.2215/CJN.10111014. Epub 2015 Sep 4. PMID: 26342045; PMCID: PMC4633798.
  5. Shang W, Li L, Ren Y, Ge Q, Ku M, Ge S, Xu G. History of kidney stones and risk of chronic kidney disease: a meta-analysis. PeerJ. 2017 Jan 24;5:e2907. doi: 10.7717/peerj.2907. PMID: 28149686; PMCID: PMC5267565.
  6. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266. PMID: 11904577.
  7. Kukreja R, Desai M, Patel SH, Desai MR. Nephrolithiasis associated with renal insufficiency: factors predicting outcome. J Endourol. 2003 Dec;17(10):875-9. doi: 10.1089/089277903772036181. PMID: 14744353.
  8. Alexander RT, Hemmelgarn BR, Wiebe N, Bello A, Morgan C, Samuel S, Klarenbach SW, Curhan GC, Tonelli M; Alberta Kidney Disease Network. Kidney stones and kidney function loss: a cohort study. BMJ. 2012 Aug 29;345:e5287. doi: 10.1136/bmj.e5287. PMID: 22936784; PMCID: PMC3431443.
  9. Jungers P, Joly D, Barbey F, Choukroun G, Daudon M. ESRD caused by nephrolithiasis: prevalence, mechanisms, and prevention. Am J Kidney Dis. 2004 Nov;44(5):799-805. PMID: 15492945.
  10. Gupta M, Bolton DM, Gupta PN, Stoller ML. Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol. 1994 Oct;152(4):1086-90. doi: 10.1016/s0022-5347(17)32509-0. PMID: 8072069.
  11. You Y, Zhang Y, Qiang L, Sun Y, Zhang J, Bou E, Yan M, Dai K, Ding M. Prevalence and risk factors for perioperative complications of CKD patients undergoing elective hip surgery. J Orthop Surg Res. 2019 Mar 20;14(1):82. doi: 10.1186/s13018-019-1118-9. PMID: 30894199; PMCID: PMC6425709.
  12. Sharma K, Slawski B. Renal disease and the surgical patient: Minimizing the impact. Cleve Clin J Med. 2018 Jul;85(7):559-567. doi: 10.3949/ccjm.85a.17009. PMID: 30004381.
  13. Kuzgunbay B, Gul U, Turunc T, Egilmez T, Ozkardes H, Yaycioglu O. Long-term renal function and stone recurrence after percutaneous nephrolithotomy in patients with renal insufficiency. J Endourol. 2010 Feb;24(2):305-8. doi: 10.1089/end.2009.0362. PMID: 20039820.
  14. Akman T, Binbay M, Aslan R, Yuruk E, Ozgor F, Tekinarslan E, Yazici O, Berberoglu Y, Muslumanoglu AY. Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol. 2012 Jan;187(1):173-7. doi: 10.1016/j.juro.2011.09.038. Epub 2011 Nov 17. PMID: 22099999.
  15. Palevsky PM. Perioperative management of patients with chronic kidney disease or ESRD. Best Pract Res Clin Anaesthesiol. 2004 Mar;18(1):129-44. doi: 10.1016/j.bpa.2003.08.003. PMID: 14760878.
  16. Prowle JR, Kam EP, Ahmad T, Smith NC, Protopapa K, Pearse RM. Preoperative renal dysfunction and mortality after non-cardiac surgery. Br J Surg. 2016 Sep;103(10):1316-25. doi: 10.1002/bjs.10186. Epub 2016 Jun 27. PMID: 27346181.
  17. Turk C, Skolarikos A, Neisius A, et al. EAU guidelines on urolithiasis. In: EAoUG Office, editor. EAU guidelines. Edn published at the 35th EAU Annual Meeting, Amsterdam. Arnhem, the Netherlands: Euro-pean Association of Urology Guidelines Office; 2020
  18. Mayo ME, Krieger JN, Rudd TG. Effect of percutaneous nephrolithotomy on renal function. J Urol. 1985 Feb;133(2):167-9. doi: 10.1016/s0022-5347(17)48867-7. PMID: 3968724.
  19. Bilen CY, Inci K, Kocak B, Tan B, Sarikaya S, Sahin A. Impact of percutaneous nephrolithotomy on estimated glomerular filtration rate in patients with chronic kidney disease. J Endourol. 2008 May;22(5):895-900. doi: 10.1089/end.2007.0435. PMID: 18393644.
  20. Canes D, Hegarty NJ, Kamoi K, Haber GP, Berger A, Aron M, Desai MM. Functional outcomes following percutaneous surgery in the solitary kidney. J Urol. 2009 Jan;181(1):154-60. doi: 10.1016/j.juro.2008.09.023. Epub 2008 Nov 14. PMID: 19013616.
  21. Izol V, Deger M, Akdogan N, Ok F, Bayazit Y, Aridogan IA. The Effect of Percutaneous Nephrolithotomy on the Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease. J Endourol. 2021 May;35(5):583-588. doi: 10.1089/end.2020.0512. Epub 2020 Nov 11. PMID: 33054416.
  22. El-Zoghby ZM, Lieske JC, Foley RN, Bergstralh EJ, Li X, Melton LJ 3rd, Krambeck AE, Rule AD. Urolithiasis and the risk of ESRD. Clin J Am Soc Nephrol. 2012 Sep;7(9):1409-15. doi: 10.2215/CJN.03210312. Epub 2012 Jun 28. PMID: 22745275; PMCID: PMC3430957.
  23. Gambaro G, Croppi E, Bushinsky D, Jaeger P, Cupisti A, Ticinesi A, Mazzaferro S, D’Addessi A, Ferraro PM. The Risk of Chronic Kidney Disease Associated with Urolithiasis and its Urological Treatments: A Review. J Urol. 2017 Aug;198(2):268-273. doi: 10.1016/j.juro.2016.12.135. Epub 2017 Mar 10. PMID: 28286070.
  24. Sairam K, Scoffone CM, Alken P, Turna B, Sodha HS, Rioja J, Wolf JS Jr, de la Rosette JJ; CROES PCNL Study Group. Percutaneous nephrolithotomy and chronic kidney disease: results from the CROES PCNL Global Study. J Urol. 2012 Oct;188(4):1195-200. doi: 10.1016/j.juro.2012.06.027. Epub 2012 Aug 15. PMID: 22901573.
  25. Kurien A, Baishya R, Mishra S, Ganpule A, Muthu V, Sabnis R, Desai M. The impact of percutaneous nephrolithotomy in patients with chronic kidney disease. J Endourol. 2009 Sep;23(9):1403-7. doi: 10.1089/end.2009.0339. PMID: 19694531.
  26. Petrova D, Petkova K, Saltirov I, Kolev Ts. Application of vibrational spectroscopy and XRD analysis for investigation of calcium oxalate kidney stones. Bulgarian Chemical Communications 2019; 51(1), 88 -95
  27. Petrova D, Petkova K, Vassilev S, Saltirov I. Patterns of preoperative urinary infection in a contemporary series of struvite stone formers undergoing percutaneous nephrolithotomy. Nephrology Dialysis Transplantation 2017;32(3):iii433.
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How to cite this article:

K.Petkova, S.Hristoforov, P. Petrov, O. Gatsev, I. Saltirov.Percutaneous nephrolithotomy in patients with chronickidney disease. Journal of Endourology and MinimallyInvasive Surgery 2021; 9 (1): 29-35Как

Corresponding author:

Dr. Kremena Petkova, MD, PhD

Military Medical Academy of SofiaDepartment of Urology and Nephrology, Clinic of Endourology and SWL

3, “Georgi Sofiiski” blvd, Sofia 1606 Bulgaria