Acute kidney injury as a predictor of infectious complicationsafter mini-PCNL

Objective: To investigate the incidence, risk factors and clinical consequences ofacute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL),with particular focus on its association with postoperative infectious complications.Materials and Methods: A retrospective analysis was conducted on 496 adultpatients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025.AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or anabsolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively.Patients were stratified into AKI and non-AKI groups. Multivariable logistic regres-sion analyses were performed to identify predictors of AKI development and infec-tious complications.Results: Surgery was done in spinal anaesthesia in all cases. AKI occurred in45 patients (9.1%). There was no difference in median surgical time (52.5 vs55.0 minutes, p = 0.33) between groups. There was no difference between the twogroups in gender distribution, median age, body mass index, baseline serum creati-nine, rates of comorbidities and stone features. Patients with AKI had significantlyhigher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) andlonger hospital stays (4 vs 3 days, p < 0.001). Infectious complications were signifi-cantly more frequent in the AKI group, with higher median procalcitonin levels (0.21vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivari-able analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) andhigher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as indepen-dent predictors of AKI. AKI was the only independent predictor of infectious compli-cations (OR 3.47, 95% CI 1.04–11.58, p = 0.04).Conclusions: The strong association between AKI and infectious complications,including potential mortality from sepsis, highlights the clinical significance of thisunderreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKIfollowing mini-PCNL