Prediction of renal function improvement after percutaneous nephrolithotomy in patients with chronic kidney disease

This study aimed to identify predictors of renal function improvement (RFI) after percutaneous nephrolithotomy (PCNL) in chronic kidney disease (CKD) patients with complex kidney stones, and to develop a predictive nomogram. A retrospective analysis was conducted on 107 enrolled patients from January 2021 to December 2024. Among the 107 enrolled patients (male-to-female ratio 2.57:1), the mean age was 58.1 ± 9.5 years. Twenty-seven point one percent exhibited RFI. Multivariable analysis revealed that higher preoperative hemoglobin (OR 1.051, 95% CI 1.021–1.038, p = 0.001), lower baseline estimated glomerular filtration rate (eGFR) (OR 0.854, 95% CI 0.789–0.924, p < 0.001), and absence of urinary tract infection (UTI) (OR 0.331, 95% CI 0.119–0.925, p = 0.035) were independently associated with RFI. Based on these parameters, a nomogram was developed. This model demonstrated a predictive accuracy of 77.9%. After bootstrapping, the calibration curve showed a mean absolute error (MAE) of 0.079. Decision curve analysis (DCA) confirmed its clinical utility across a wide probability threshold (15–94%). In summary, a nomogram based on preoperative hemoglobin, eGFR, and UTI status can help predict RFI after PCNL. Managing anemia and infection before surgery is crucial to improving outcomes in these high-risk patients.