title: Renal functional effects of simultaneous bilateral single-tract percutaneous access in pigs.
abstract: OBJECTIVE
  To present our findings of simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) on bilateral renal haemodynamic and excretory function in an in vivo pig model, as despite sbPCNL being a treatment strategy for patients with bilateral renal stones, the functional response of both kidneys to such a procedure is unknown.
  
  
  METHODS
  Nine anaesthetized female pigs ( approximately 70 kg) had a single-tract PCNL procedure in the left kidney and then the right kidney in one session (sbPCNL). Percutaneous access was achieved by a 30 F balloon dilator system. Bilateral renal function was measured before, 1.5 and 4.5 h after sbPCNL and included glomerular filtration rate (GFR), effective renal plasma flow (RPF), renal extraction of para-aminohippurate (EPAH, a measure of the efficiency of tubular organic anion transport), urine flow (UV), absolute sodium excretion (UNaV) and fractional sodium excretion (FENa).
  
  
  RESULTS
  Both kidneys had similar baseline haemodynamic and excretory function, and showed comparable changes after sbPCNL. Bilateral GFR and RPF decreased by approximately 35% at 1.5 and 4.5 h after sbPCNL; EPAH was reduced to a similar degree in both kidneys at 1.5 h after sbPCNL and remained depressed throughout the observation period; bilateral UV and UNaV progressively decreased by approximately 30% and approximately 60% at 1.5 and 4.5 h after sbPCNL, respectively; bilateral FENa did not significantly change at 1.5 h after sbPCNL but decreased significantly by approximately 50% at 4.5 h.
  
  
  CONCLUSIONS
  Both kidneys responded in a similar fashion after sbPCNL, with declines in haemodynamic and excretory function. These bilateral functional responses were comparable to those previously reported after unilateral PCNL, and help to reduce concerns that PCNL of both kidneys in one session could lead to greater functional complications, at least acutely.
authors.affiliation: Department of Anatomy & Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA. rajash_handa@hotmail.com
authors.forename: Rajash K
authors.initials: RK
authors.lastname: Handa
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Johnson
authors.forename: Bret A
authors.initials: BA
authors.lastname: Connors
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Evan
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D017597:Renal Blood Flow, Effective / Q000502:physiology; D012964:Sodium / Q000652:urine; D013552:Swine; D010130:p-Aminohippuric Acid / Q000652:urine
chemical_list: D012964:Sodium; D010130:p-Aminohippuric Acid