Srivastava A et al, 2012: Percutaneous nephrolithotomy in polycystic kidney disease: is it safe and effective?
Srivastava A, Bansal R, Srivastava A, Chaturvedi S, Ranjan P, Ansari MS, Yadav A, Kapoor R
Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India
PURPOSE: Nephrolithiasis is common in patients with autosomal dominant polycystic kidney disease (ADPKD). Percutaneous management of nephrolithiasis is challenging because of a large number of parenchymal cysts and distorted calyceal anatomy. These patients also have varying grades of chronic kidney disease and are at increased risk of bleeding, which further increases the challenge. The objective of the study is to study the efficacy and safety of PCNL in ADPKD.
MATERIALS AND METHODS: We retrospectively analyzed twenty-two patients of ADPKD with renal calculi managed by percutaneous nephrolithtomy (PCNL) from January 2000 to January 2010. Patients were divided into two groups: group I (serum creatinine ≤1.5 mg%), group II (serum creatinine >1.5 mg%).
RESULTS: PCNL was done in 25 renal units among 22 patients. Sixteen patients had chronic kidney disease, and the average stone burden was 2.4 cm ± 0.8 cm. The overall success rate (complete stone clearance/residual fragments required ESWL for the incomplete clearance. Mean preoperative serum creatinine in group I was 0.9 ± 0.1 mg% and in group II 3.1 ± 1.2 mg%. There was improvement in serum creatinine in group II (1.4 ± 0.5 mg%) postoperatively. Three patients required blood transfusion (13%) and four patients had fever postoperatively (18%). None of the patients required angioembolization.
CONCLUSION: Despite the distorted calyceal anatomy and associated chronic kidney disease, PCNL is safe and effective in managing nephrolithiasis in polycystic kidney disease.
Int Urol Nephrol. 2012 Jun;44(3):725-30. doi: 10.1007/s11255-011-0090-z. Epub 2011 Nov 20
PMID:22102138 [PubMed - as supplied by publisher]
This article mainly reports the success of PNL in patients with polycystic disease. ESWL is mentioned just because it was as an auxiliary procedure in one patient.