INTRODUCTION AND OBJECTIVES: Though considered standard of care for symptomatic urolithiasis, few data are available evaluating the effects of multiple ureteroscopic laser lithotripsies (URS) on long term renal function.
We investigated this relationship in a population with pre-existing mild to moderate kidney disease. Prior studies have been limited by estimates of glomerular filtration rate (eGFR) calculated from creatinine during acute stone obstruction, and inclusion of patients with a history of other stone procedures, such as shockwave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL).
METHODS: Charts were reviewed for patients with a baseline eGFR below 90 mL/min/1.73m2 who underwent at least 2 URS for nephrolithiasis at our institution from 2004-2012. Patients undergoing SWL or PCNL at any point in their history were excluded. A total of 26 patients, with a mean of 2.3 ± 0.6 URS procedures, were included. Estimated GFR was recorded at baseline prior to acute stone presentation and surgery, and at the last recorded follow-up visit. Stone location, total stone burden, and co-morbidities were also recorded.
RESULTS: The mean eGFR changed from 68.0 ± 13.3 to 75.4 ± 23.0 mL/min/1.73m2 (mean increase of 10.1 ± 25.0%; mean annual increase of 3.8 ± 15.3%) over a mean follow-up period of 28.1 months (range: 5-75 months). There was no significant difference in eGFR change between patients with stones treated in the kidney alone versus the ureter and kidney combined (12.1% vs. 8.3% mean increase; p=0.74). Age, presence of DM or HTN, baseline creatinine level, total stone burden, and number of URS performed were not significantly associated with change in eGFR.
CONCLUSIONS: Using eGFR measured prior to acute stone presentation, our results suggest that multiple ureteroscopies for stones are not detrimental to long term renal function, even in patients with pre-existing stage 2-3 chronic kidney disease.
Written by:
Sninsky BC, Jhagroo RA, Astor BC, Nakada SY. Are you the author?
University of Wisconsin School of Medicine and Public Health, Urology, Madison, Wisconsin, United States.
Reference: J Endourol. 2014 Jun 10. Epub ahead of print.
doi: 10.1089/end.2014.0322
PubMed Abstract
PMID: 24915495
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