CHRONIC-RENAL-FAILURE AND NEPHROLITHIASIS IN A SOLITARY KIDNEY - ROLEOF INTERVENTION

Purpose: We determined the role of intervention and its outcome in pat ients with a solitary kidney, nephrolithiasis and chronic renal insuff iciency, as well as the role of clearance in these patients compared t o those with a solitary kidney, nephrolithiasis and normal renal funct ion. Materials and Methods: A total of 36 records was evaluable, inclu ding 16 from patients with normal (group 1) and 20 from those with abn ormal (group 2) renal function. Group 2 was further subdivided into th ose with mild to moderate (group 2A) and advanced (group 2B) renal fai lure, Patients with acute renal failure were excluded from the study. Glomerular filtration rate was calculated by the Cockcroft and Gault f ormula. The reciprocal of serum creatinine was used to determine outco me. Results: Groups 1 and 2 were comparable demographically except for serum creatinine, stone bulk and hospital. stay. Of 36 patients 8 wit h normal renal function and 15 with chronic renal failure underwent pe rcutaneous nephrolitholapaxy, 6 underwent extracorporeal shock wave li thotripsy and 7 underwent open surgery. Total clearance was achieved i n 25 of 36 patients (72%). Glomerular filtration rate improved in 24 p atients, remained stable in 8 and deteriorated in 4. However, 3 patien ts had less than 20% deterioration and 1 had significant deterioration in function after intervention. Improvement in glomerular filtration rate after intervention was significantly greater in cases of advanced renal failure. Patients with residual stones did worse than those wit hout residual calculi. Mean hospital stay, deterioration in glomerular filtration rate and major morbidity rate were significantly greater i n patients with residual calculi than in those with total clearance. C onclusions: Intervention should be contemplated in patients with a sol itary kidney, stone disease and renal failure as in any other patient with stone disease, with the aim being total clearance. Stone eradicat ion delays deterioration, and decreases the requirement for dialysis a nd renal replacement.