title: Percutaneous nephrolithotomy in polycystic kidney disease: is it safe and effective?
abstract: OBJECTIVE
  Nephrolithiasis is common in patients with autosomal dominant polycystic kidney disease (ADPKD). Percutaneous management of nephrolithiasis is challenging because of a large number of parenchymal cysts and distorted calyceal anatomy. These patients also have varying grades of chronic kidney disease and are at increased risk of bleeding, which further increases the challenge. The objective of the study is to study the efficacy and safety of PCNL in ADPKD.
  
  
  METHODS
  We retrospectively analyzed twenty-two patients of ADPKD with renal calculi managed by percutaneous nephrolithtomy (PCNL) from January 2000 to January 2010. Patients were divided into two groups: group I (serum creatinine ≤ 1.5 mg%), group II (serum creatinine >1.5 mg%).
  
  
  RESULTS
  PCNL was done in 25 renal units among 22 patients. Sixteen patients had chronic kidney disease, and the average stone burden was 2.4 cm ± 0.8 cm. The overall success rate (complete stone clearance/residual fragments <4 mm) was 88% (22/25). Two patients required relook PCNL for residual stone and one required ESWL for the incomplete clearance. Mean preoperative serum creatinine in group I was 0.9 ± 0.1 mg% and in group II 3.1 ± 1.2 mg%. There was improvement in serum creatinine in group II (1.4 ± 0.5 mg%) postoperatively. Three patients required blood transfusion (13%) and four patients had fever postoperatively (18%). None of the patients required angioembolization.
  
  
  CONCLUSIONS
  Despite the distorted calyceal anatomy and associated chronic kidney disease, PCNL is safe and effective in managing nephrolithiasis in polycystic kidney disease.
authors.affiliation: Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India.
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bansal
authors.forename: Alok
authors.initials: A
authors.lastname: Srivastava
authors.forename: Samit
authors.initials: S
authors.lastname: Chaturvedi
authors.forename: Priyadarshi
authors.initials: P
authors.lastname: Ranjan
authors.forename: M S
authors.initials: MS
authors.lastname: Ansari
authors.forename: Abhishek
authors.initials: A
authors.lastname: Yadav
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D002606:Charcoal; D003404:Creatinine / Q000097:blood*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007669:Kidney Calculi / Q000097:blood / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D016891:Polycystic Kidney, Autosomal Dominant / Q000097:blood / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications; D012189:Retrospective Studies
chemical_list: D002606:Charcoal; D003404:Creatinine
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