ABSTRACT Objective: The objective of this study is to assess the effectiveness of PCNL in children with deranged renal functions and to compare the safety and efficacy of PCNL in these patients with those having normal renal functions. Methodology: Retrospective data for patients treated with percutaneous nephrolithotomy in a 3year period were collected. Serum creatinine (SCr) value of 0.7 mg/dL was set as cut off point. The patients who had creatinine level of <0.7 mg/dL labeled as having normal GFR (Group 1) while children having creatinine levels >0.7 mg/dL were categorized as having decreased GFR (Group 2). Stone clearance rate (SCR), hospital stay and mean change in hemoglobin and hematocrit were primary study outcomes. While complications of PCNL were secondary study outcomes. Results: We evaluated 307 children in which male were 202(65.8%) while female were 105(34.2%), median age was 7. Median operative time was 80 minutes while median duration of stay in hospital was 4 days. Median length of stone was 1.5 cm while breadth was 1.3 cm. Most of stones were located in pelvic region (266), followed by 131 in lower calyx, 49 were in upper calyx and 40 were in mid calyx. In 301(98%) patients single tract was made while double tract was made in 6(2%) patients. Post-operative complications like need of blood transfusion, fever, pleural tap and urosepsis were not associated with deranged renal function (p value ≥ 0.05). Complete stone free rate was less in patients with decreased renal functions (p value=0.027). Pre-operative and post-operative differences of HB, HCT and creatinine levels were same in both groups of patients (p value ≥0.05). Conclusions: PCNL is an effective feasible intervention for patients with chronic renal insufficiency and acceptable complication rates. Therefore, careful patient selection and through surgical practice is required to yield favorable outcomes.

Keywords: Pediatric urolithiasis, Percutaneous nephrolithotomy, stone clearance rate.