Kidney stone | Figure 1
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Kidney stone
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What are the benefits and risks of tranexamic acid for percutaneous nephrolithotomy for the treatment of kidney stones?
Key messages
- Tranexamic acid, when compared to placebo (or no medication), may reduce blood transfusions, surgical complications, and a patient's hospital stay following percutaneous nephrolithotomy.
- Tranexamic acid, when compared to placebo (or no medication), may improve the removal of stone material following percutaneous nephrolithotomy but may increase unwanted medication effects.
- We do not know if tranexamic acid affects the risk of blood clots forming in other parts of the body following percutaneous nephrolithotomy.
What did we want to find out?
We wanted to find out if giving tranexamic acid was better (or worse) than not giving tranexamic acid. The main outcomes we were interested in were blood transfusions, completeness of stone removal, and the risk of blood clots forming in other parts of the body. We also studied unwanted medication effects, the need for more stone procedures, major and minor surgical complications, unplanned returns to the hospital, and length of stay in the hospital.
What did we find?
We found 10 studies that used tranexamic acid as an infusion by vein and one study that added tranexamic acid to the irrigation fluid. Based on these studies, tranexamic acid may reduce blood transfusions and improve stone removal. However, we do not know if tranexamic acid affects blood clots forming in other parts of the body when infused by a vein, or added to the irrigation fluid used for percutaneous nephrolithotomy.
What are the limitations of the evidence?
We have little confidence in most of the evidence, and for some of the results, we are confident in the evidence. Reasons for low confidence include concerns about whether participants in both groups were managed and evaluated the same way. Also, in some instances, the results of the included studies were quite different, the studies were small, or there were not enough studies to be sure of the effect.
A 22-year-old male, mayor by trade, who has presented recurrent colic-type pain and pain when urinating, has a history of renal colic secondary to kidney stones, resolved in a hospital entitled 2 months ago.
He denies personal pathological and hereditary family history. He denies drug addiction. The patient lives at sea level and denies having traveled to areas of higher altitude in recent months. After the last treatment, he has continued with burning pain when urinating, which makes him return to his family medicine unit.
Blood and urine studies are performed, finding the following:
- Hematic biometry: leukocytes 11.25, Erythrocytes: 5.96 M/μL, Hemoglobin: 16.62 g/dL, hematocrit: 52.51%, Mean corpuscular hemoglobin: 27.88 pg, Mean corpuscular hemoglobin concentration: 31.66 g/dL, erythrocyte distribution width: 11.10%, Neutrophils: 31.19%, Monocytes: 8.49%, Eosinophils: 23.75%, Lymphocytes: 3.93 K/μL, Monocytes: 0.96 K/μL, Eosinophils: 2.67 K/μL, Basophils: 0.18 K/μL, Mean platelet volume: 12.66 fL.
- General urine test: amorphous urate "+", rest normal. Negative bacteria and negative urine culture. Imaging studies (kidney and urinary tract ultrasound) are pending.
Probable causes of alteration of the red series? Cólico renal y alteraciones en serie roja Masculino de 22 años de edad, intendente de oficio, el cual ha presentado dolor tipo cólico recurrente y dolor al orinar, presenta antecedente de cólico renal secundario a litiasis renal, resuelto en hospital de derechohabiencia hace 2 meses.