To evaluate the prevalence, predictors, and progression of acute kidney injury (AKI) in patients undergoing mPCNL for nephrolithiasis.
We retrospectively analyzed data from 569 patients who underwent mPCNL at a single tertiary academic center (01/2016-10/2024). AKI was defined per KDIGO criteria as sCr increase >0.3 mg/dL or ≥1.5× baseline. Stone-free status was no residual stones on CT at 3-month follow-up. Complications were classified using the modified Clavien system. Kidney function was reassessed 30-90 days post-op. Descriptive statistics, logistic regression, and Cox regression were applied.
Median (IQR) age and stone volume were 57 (48-66) years and 2.1 (0.9-4.2) cm³. Median preoperative sCr and operative time were 0.9 (0.7-1.1) mg/dL and 90 (73-120) minutes. Post-mPCNL, 40 patients (7.0%) developed AKI. Complications occurred in 138 (24.2%) patients; 449 (78.9%) were stone-free. AKI patients had higher CCI (1.3 vs. 0.5, p=0.04), pre-op sCr (1.1 vs. 0.8 mg/dL, p<0.01), stone volume (5.7 vs. 2 cm³, p=0.02), and longer operative time (130 vs. 90 min, p=0.01). Complications were more frequent in AKI patients (42.5% vs. 22.8%, p=0.01). At multivariate analysis, operative time (OR 1.1, p=0.03), pre-op sCr (OR 3.8, p=0.001), and early complications (OR 2.5, p=0.02) were independently associated with AKI. AKI persisted in 9 (22.5%) patients, mainly those with complications (88.9% vs. 38.7%, p=0.01). On Cox analysis, lower BMI (HR 0.8, p=0.02) and absence of complications (HR 0.3, p=0.01) predicted faster AKI recovery.
Acute kidney injury remains a clinically significant complication following mPCNL.
International braz j urol : official journal of the Brazilian Society of Urology. 2026 Jan [Epub]
Federica Passarelli, Ludovico Maria Basadonna, Fabio Ciamarra, Edoardo Bonacina, Giorgio Graps, Edoardo Sorba, Valentina Parolin, Gianpaolo Lucignani, Francesco Ripa, Stefano Paolo Zanetti, Fabrizio Longo, Elisa De Lorenzis, Giancarlo Albo, Emanuele Montanari, Luca Boeri
Department of Urology, IRCCS Fondazione Ca' Granda, Policlinico di Milano, Milan, Italy.