Improvement in serum creatinine following definite treatment of urolithiasis in patients with concurrent renal insufficiency

Objective: To assess whether definitive treatment of urolithiasis following relief of obstruction in patients with renal insufficiency results in further improvement in renal function as determined by serum creatinine. Methods: In a review of 500 patients with urolithiasis, we identified 43 (12%) patients with serum creatinine level of ≥176 μmol/l at the time of presentation. Location and complexity of calculi, type of procedure required to render the patients stone free and effects of surgical intervention (following relief of obstruction) on renal function were evaluated. Results: Mean serum creatinine at presentation was 555 μmol/l and after relief of obstruction was 361 μmol/l. Mean serum creatinine level after surgical intervention dropped to 193 μmol/l (p < 0.001). Complete or partial staghorn calculi were seen in 40% of patients. Two-thirds of patients required more than one procedure for complete stone clearance. Conclusions: Renal calculi and concurrent mild to moderate renal insufficiency warrants aggressive treatments. Patients demonstrate significant improvement in renal function independent of relief of obstruction.