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Paymannejad S, Dehghani M, Dehkordi RJ, Taheri S, Shamlou F, Salehi H, Kazemi R. Prevalence of acute kidney injury following percutaneous nephrolithotomy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:17. [PMID: 38808219 PMCID: PMC11132422 DOI: 10.4103/jrms.jrms_317_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 05/30/2024]
Abstract
Background The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001). Conclusion The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus).
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Affiliation(s)
- Saina Paymannejad
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Dehghani
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Jafari Dehkordi
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Taheri
- Department of Internal Medicine, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farid Shamlou
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Salehi
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Kazemi
- Department of Urology, Al-Zahra Institute Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kharazmi F, Hosseini-Dastgerdi H, Pourshanazari AA, Nematbakhsh M. The denervation or activation of renal sympathetic nerve and renal blood flow. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:76. [PMID: 38152073 PMCID: PMC10751519 DOI: 10.4103/jrms.jrms_216_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 12/29/2023]
Abstract
The denervation or activation of the sympathetic nerve in the kidney can affect renal hemodynamics. The sympathetic nervous system regulates the physiological functions of the kidneys. Stimulation of sympathetic efferent nerves affects various parameters related to renal hemodynamics, including sodium excretion, renin secretion, and renal blood flow (RBF). Hence, renal sympathetic fibers may also play an essential role in regulating systemic vascular resistance and controlling blood pressure. In the absence of renal nerves, the hemodynamics response to stimuli is negligible or absent. The effect of renal sympathetic denervation on RBF is dependent on several factors such as interspecies differences, the basic level of nerve activity in the vessels or local density of adrenergic receptor in the vascular bed. The role of renal denervation has been investigated therapeutically in hypertension and related disorders. Hence, the dynamic impact of renal nerves on RBF enables using RBF dynamic criteria as a marker for renal denervation therapy.
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Affiliation(s)
- Fatemeh Kharazmi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hajaralsadat Hosseini-Dastgerdi
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehdi Nematbakhsh
- Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Physiology, Isfahan University of Medical Sciences, Isfahan, Iran
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