Kidney Week

Abstract: FR-PO247

Acute Kidney Disease (AKD) following Ureteroscopy and Laser Lithotripsy: The Latest Frontier for Nephrologists

Session Information

• Mineral Bone Disease: Transplant and Kidney Stones
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Trevisani, MD, PhD

• Candela, Luigi, IRCCS Ospedale San Raffaele, Milano, Italy

Luigi Candela

• Ventimiglia, Eugenio, IRCCS Ospedale San Raffaele, Milano, Italy

Eugenio Ventimiglia, DrPH

• d'Arma, Alessia, IRCCS Ospedale San Raffaele, Milano, Italy

Alessia d'Arma, MSc, PhD

• Corsini, Christian, IRCCS Ospedale San Raffaele, Milano, Italy

Christian Corsini, MD

• Robesti, Daniele, IRCCS Ospedale San Raffaele, Milano, Italy

Daniele Robesti

• Traxer, Olivier, Tenon hospital, Parigi, France

Olivier Traxer, MD

• Montorsi, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Montorsi

• Salonia, Andrea, IRCCS Ospedale San Raffaele, Milano, Italy

Andrea Salonia

• Villa, Luca, IRCCS Ospedale San Raffaele, Milano, Italy

Luca Villa, MD

Background

Ureteroscopy (URS) with laser lithotripsy is the gold-standard for treating ureteral and kidney stones up to 2 cm, but complications can occur in up to 25% of cases. AKI post-URS is underestimated due to exclusive urological management. AKD, a transient kidney function alteration lasting less than 90 days, is under-researched despite its high CKD risk. This study aims to evaluate the occurrence and evolution of AKD in stone patients treated with URS.

Methods

A consecutive cohort of 284 patients treated with URS for urinary stones in a tertiary institution was considered. According to KDIGO 2023, AKD was defined as postoperative acute kidney injury (AKI) occurrence, estimated glomerular filtration rate (eGFR) decrease ³35%, or serum creatinine (SCr) increase ³50%. AKI was defined as SCr increase ³0.3 mg/dL or ³50%. AKD evolution was evaluated 60 days post-URS. Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients’ characteristics and perioperative data with the occurrence of AKD.

Results

Descriptive statistic is shown in table 1. Overall, postoperative AKD occurred in 32 (11.3%) patients. Recovery from AKD was found in 26 (82%) patients and persistent AKD occurred in 6 (18%) patients. At UVA, age at surgery (p=0.05), baseline SCr (p=0.02), baseline CKD category (p=0.006), Charlson comorbidity index (p=0.01), operative time (p=0.04) and postoperative complications (<0.001) were associated with AKD (table 2). At MVA, CKD category (OR 2.99, 95% CI= 1.4-6.3; p=0.004), operative time (OR 1.01, 95% CI=1.001-1.018; p=0.023) and postoperative complications (OR 3.5, 95% CI=1.46-8.49; p=0.005) were independent predictors of AKD. (table 3)

Conclusion

AKD is a frequent insidious complication in patients treated with URS. Therefore, a tailored nephrological assessment should be mandatory.