Category: Clinical Stones: PCNL

MP12-19 - Assessment of Acute Kidney Injury Risk in Patients undergoing PCNL

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Acute kidney injury (AKI) is a serious complication in hospitalized patients following surgery that can result in significant morbidity and mortality if not identified and managed promptly. Patients undergoing percutaneous nephrolithotomy (PCNL) are perhaps even more vulnerable to AKI given the likelihood of pre-existent comorbidities as well as the variable operative stress of percutaneous renal surgery. The goal of our study was to determine the prevalence of AKI and its predictive factors and clinical outcomes in patients undergoing PCNL.

Methods :

With IRB approval, we retrospectively identified 211 patients who underwent PCNL between 2010-2016. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) guidelines as an increase in serum creatinine greater than 0.3 mg/dL from reference creatinine levels. We included all patients over the age of 18 admitted to the hospital for longer than 24 hours following primary PCNL and excluded patients with end-stage renal disease prior to surgery. A multivariable regression analysis was then used to determine associations between preoperative factors, AKI, and outcomes. ROC analysis was used to assess predictive performance of our regression model.

Results :

Overall prevalence of AKI was 28.4% (60/211). On multivariate analysis, the prevalence of AKI was strongly associated with BMI (p = 0.036), advanced age (p 0.02), and preoperative histories of cerebrovascular disease (p = 0.025) and chronic pulmonary disease (p = 0.039). ROC analysis yielded an AUC of 0.8 (95% CI : 0.70-0.90) for our regression model. In terms of outcomes, patients with AKI were more likely to develop post-operative complications (p < 0.001) including myocardial infarction (p = 0.003) and sepsis (p <0.001), have longer hospital length of stay (p < 0.001), and higher mortality at 6 and 12 months (p = 0.037).

Conclusions :

AKI is a common complication following PCNL that is associated with a higher risk of additional post-operative complications, increased hospital stay, and mortality. Preoperative AKI assessment should be considered for all high-risk patients during surgical planning and patient decision-making. Our next step is inclusion of intra-operative parameters to further delineate the weight of risk factors associated with postoperative AKI.

Vincent G. Bird

Professor of Urology
University of Florida College of Medicine, Department of Urology
Gainseville, Florida

Dr. Vincent G. Bird is currently Professor in the Department of Urology, Chief of the Division of Minimally Invasive Surgery, the endourology and minimally invasive surgery fellowship program co-director, and associate program director of the residency program in the Department of Urology at the University of Florida College of Medicine. Dr. Bird completed his fellowship training in robotics, laparoscopy and endourology at the University of Iowa Hospitals and Clinics. At the conclusion of his fellowship, Dr. Bird was recognized for excellence in clinical science by the Endourological Society for research relating to patterns of treatment for urinary stone disease.
Dr. Bird received his undergraduate education at Boston University, and attended medical school at the State University of New York, Stony Brook, where he received his medical degree with distinction in research and was also awarded for his work involving cellular processes related to cancer and inflammation. Dr. Bird then completed his general surgical and urological training at the University of Miami. Currently, his clinical practice focuses on renal surgery for urinary stone disease, renal obstruction, and renal cancer, while his clinical and basic science research focus is on the treatment of a variety of renal conditions. He also has publications and interests relating to urologic imaging. He has contributed publications on treatment of urinary stone disease with newly developed technologies.
Dr. Bird is also an active member of the American Urological Association, Southeastern Section of the American Urological Association, Endourological Society, and past president of the Florida Urological Society. Dr. Bird has held a number of positions within the Florida Urologic Society, serving two terms as scientific director as well as secretary treasurer. He serves as a reviewer for a number of Urology based journals.

Nitin Sharma

Clinical Fellow
University of Florida College of Medicine, Department of Urology
Chicago, Illinois

Shahab Bozorgmehri

University of Florida College of Medicine, Department of Epidemiology
Gainesville, Florida

Brandon Otto

University of Florida College of Medicine, Department of Urology
Gainesville, Florida

Azra Bihorac

Gainesville, Florida