Journal Article

Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones

Danilovic, Alexandre, Mazzucchi, Eduardo, Marchini, Giovanni Scala, Batagello, Carlos, Torricelli, Fabio Cesar Miranda, Nahas, William C., Suartz, Caio Vinicius, Vicentini, Fabio Carvalho

2024

Overview

Purpose We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. Methods From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. Results Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR ( p  < 0.001) were significantly lower, and POD10 ( p  = 0.092) and POD30 ( p  = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m 2 , p  = 0.019 [1.021–1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p  = 0.028 [1.25–51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p  = 0.042 [1.00–1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p  = 0.026 [0.016–0.773; 0.113]. Conclusions Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Calculi / Creatinine / Epidemiology / Epidermal growth factor receptors / Glomerular filtration rate / Kidney diseases / Kidney stones / Medicine / Medicine & Public Health / Multivariate analysis / Nephrolithiasis / Nephrology / Oncology / Original Article / Renal function / Risk factors / Urology