Acute effects of percutaneous tract dilation on renal function and structure

Rajash Handa, Brian R. Matlaga, Bret A. Connors, Jun Ying, Ryan F. Paterson, Ramsay L. Kuo, Samuel C. Kim, James E. Lingeman, Andrew Evan, Lynn R. Willis

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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. Materials and 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 (UNaV) 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 UNaV 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. Conclusion: Both animal and human studies show that PCN is associated with an acute decline in renal function.

Original languageEnglish
Pages (from-to)1030-1040
Number of pages11
JournalJournal of Endourology
Volume20
Issue number12
DOIs
StatePublished - Dec 2006

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Percutaneous Nephrostomy
Dilatation
Kidney
Renal Plasma Flow
Swine
Glomerular Filtration Rate
Economic Inflation
Punctures
Creatinine
Hemodynamics
Sodium
Observation

ASJC Scopus subject areas

  • Urology

Cite this

Handa, R., Matlaga, B. R., Connors, B. A., Ying, J., Paterson, R. F., Kuo, R. L., ... Willis, L. R. (2006). Acute effects of percutaneous tract dilation on renal function and structure. Journal of Endourology, 20(12), 1030-1040. https://doi.org/10.1089/end.2006.20.1030

Acute effects of percutaneous tract dilation on renal function and structure. / Handa, Rajash; Matlaga, Brian R.; Connors, Bret A.; Ying, Jun; Paterson, Ryan F.; Kuo, Ramsay L.; Kim, Samuel C.; Lingeman, James E.; Evan, Andrew; Willis, Lynn R.

In: Journal of Endourology, Vol. 20, No. 12, 12.2006, p. 1030-1040.

Research output: Contribution to journalArticle

Handa, R, Matlaga, BR, Connors, BA, Ying, J, Paterson, RF, Kuo, RL, Kim, SC, Lingeman, JE, Evan, A & Willis, LR 2006, 'Acute effects of percutaneous tract dilation on renal function and structure', Journal of Endourology, vol. 20, no. 12, pp. 1030-1040. https://doi.org/10.1089/end.2006.20.1030
Handa, Rajash ; Matlaga, Brian R. ; Connors, Bret A. ; Ying, Jun ; Paterson, Ryan F. ; Kuo, Ramsay L. ; Kim, Samuel C. ; Lingeman, James E. ; Evan, Andrew ; Willis, Lynn R. / Acute effects of percutaneous tract dilation on renal function and structure. In: Journal of Endourology. 2006 ; Vol. 20, No. 12. pp. 1030-1040.
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AU - Handa, Rajash

AU - Matlaga, Brian R.

AU - Connors, Bret A.

AU - Ying, Jun

AU - Paterson, Ryan F.

AU - Kuo, Ramsay L.

AU - Kim, Samuel C.

AU - Lingeman, James E.

AU - Evan, Andrew

AU - Willis, Lynn R.

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N2 - 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. Materials and 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 (UNaV) 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 UNaV 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. Conclusion: Both animal and human studies show that PCN is associated with an acute decline in renal function.

AB - 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. Materials and 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 (UNaV) 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 UNaV 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. Conclusion: Both animal and human studies show that PCN is associated with an acute decline in renal function.

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