Predicting acute kidney injury after endourological treatment of Kidney stones.

Introduction and Objective: Postoperative acute kidney injury (AKI) can occur after Percutaneous Nephrolithotomy (PCNL). This study aimed to assess AKI incidence after standard and mini-PCNL and identify associated risk factors. Methods: A retrospective analysis of prospectively collected data from 1,398 patients undergoing PCNL (2005-2024) at a single institution was carried out. Only patients with renal stones into bilaterally anatomically normal kidneys were included. AKI was defined by KDIGO criteria as at least a ≥1.5-fold or ≥0.3 mg/dL increase in baseline serum creatinine (sCr) within 72 hours postoperatively. Multivariable logistic regression analyzed predictors of AKI. Results: AKI occurred in 153 (10.9%) patients, classified as stage I, II, and III in 8.0%, 2.0%, and 0.9%, respectively. Major complications increased with AKI severity, notably infections and bleeding requiring angioembolization, leading to AKI patients having a longer postoperative hospital stay. Independent predictors included older age (OR 1.05 per year; 95%CI 1.03–1.07), female gender (OR 1.66; 95%CI 1.14–2.43), baseline eGFR (U-shaped relationship: linear term OR 0.50 per 10-unit increase; 95%CI 0.36–0.68, quadratic term OR 1.06 per 10-unit increase; 95%CI 1.04–1.08), larger tract size >22 Ch (OR 2.29; 95%CI 1.53–3.44), surgical time (OR 1.01 per minute; 95%CI 1.01–1.01), intraoperative hemoglobin loss (OR 1.16 per g/dL; 95%CI 1.05–1.29), minor complications (Clavien grade 1–2, OR 2.29; 95% CI 1.49–3.51), and major complications (Clavien grade≥3, OR 6.08; 95% CI 3.57–10.35). Conclusion: AKI following PCNL significantly affects postoperative morbidity and hospitalization. Risk factors include age, gender, baseline renal function, sheath size, surgical time, hemoglobin loss, and postoperative complications. Given the potential negative effects of AKI, urologists should be aware and pay attention to the non-negligible incidence of such event after PCNL, particularly in patients “at risk”