FACTORS AFFECTING RENAL FUNCTION FOLLOWING PERCUTANEOUS NEPHROLITHOTRIPSY

Introduction. Urolithiasis is one of the most common urologic diseases. Percutaneous nephrolithotripsy (PCNL) represents the gold standard of treatment for patients with stones larger than 2 cm; however, in some cases, this procedure may lead to deterioration of renal function, so studying the factors that determine the effect of PCNL on renal function is of particular importance. Objective. To analyze the literature data and determine the factors responsible for the negative effect of percutaneous nephrolithotripsy on renal function Material and Methods. PubMed library and Elibrary were searched using the keywords: nephrolithiasis, PCNL, renal function, creatinine, mini-PCNL, nephrolithiasis, нефролитиаз, ПНЛТ, функция почки, креатинин, мини-ПНЛТ; logical operators (are, or) for Boolean search were also used. Based on inclusion (study is relevant to the topic/reported on kidney function) and exclusion criteria (studies with a sample size of less than 10 patients; published before 2000; not available in English or Russian), 33 studies were included in this review of the literature. Results. Since serum creatinine cannot most accurately reflect the early effects of PCNL on renal function, it is reasonable to use other biomarkers of acute kidney injury (AKI) (Cys C, NGAL, KIM-1). The less damage to the renal parenchyma, the less pronounced is the negative impact of the operation on renal function; therefore, miniaturization of access during PCNL, as well as single access to the renal calyx, is accompanied by a smaller decrease in renal function. Also, renal status after PCNL depends on the timing of surgery. In addition, miniaturization of access during PCNL is associated with a lower risk of intraoperative and postoperative complications. Removal of large, dense, and staghorn stones is associated with a high risk of AKI. Additionally, the presence of renal failure, arterial hypertension, diabetes mellitus, preoperative urinary tract infection, previous renal surgery, and low preoperative hemoglobin are risk factors for postoperative deterioration of renal function. Conclusion. PCNL is the gold standard for the treatment of patients with large stones. Typically, renal function is not compromised after this procedure, but extensive damage to the renal parenchyma, multiple access to the renal calyx, comorbid conditions (baseline renal insufficiency, hypertension, diabetes mellitus), large or staghorn stones, preoperative urinary tract infection, history of renal surgery, and low preoperative hemoglobin may contribute to the negative impact of PCNL on renal function.