Acute effects of percutaneous tract dilation on renal function and structure.
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is performed on a routine basis for the rapid and efficient removal of large caliceal stones. After percutaneous puncture, rigid dilators or an inflatable balloon are used to dilate the nephrostomy tract to allow access to the collecting system for stone removal. Little is known of the acute impact of tract dilation procedures on renal function.


METHODS
We compared renal hemodynamic and excretory function in female pigs immediately before and up to 5 hours after percutaneous nephrostomy (PCN) using sequential Amplatz dilators (N = 8) or Nephromax balloon inflation (N = 7) and control pigs with no PCN access (N = 8). We also examined renal function in patients undergoing PCNL.


RESULTS
The two PCN procedures produced a renal lesion of comparable size and morphology, as well as similar changes in renal function. Glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary sodium excretion (U(Na)V) were significantly reduced in Amplatz- and Nephromax-treated kidneys throughout the 5-hour observation period, by about 50%, 60%, and 80%, respectively. In control pigs, GFR and RPF remained stable and U(Na)V declined progressively to about 50% of baseline over the course of the experiment. The contralateral kidney showed changes in renal function similar to those in the PCN-treated or control kidney in all three groups. A retrospective analysis of 196 adults with normal renal function who underwent unilateral PCNL using the Nephromax balloon dilator revealed a significant increase in serum creatinine of 0.14 mg/dL at 1 day.


CONCLUSIONS
Both animal and human studies show that PCN is associated with an acute decline in renal function.
Handa
Rajash K
RK
Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. rhanda@iupui.edu
Matlaga
Brian R
BR
Connors
Bret A
BA
Ying
Jun
J
Paterson
Ryan F
RF
Kuo
Ramsay L
RL
Kim
Samuel C
SC
Lingeman
James E
JE
Evan
Andrew P
AP
Willis
Lynn R
LR
D000818:Animals; D001794:Blood Pressure; D003401:Creatine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology / Q000502:physiology* / Q000601:surgery*; D007674:Kidney Diseases / Q000097:blood / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D009403:Nephrostomy, Percutaneous; D013552:Swine / Q000502:physiology*; D013997:Time Factors
D003401:Creatine