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Özlü DN, Ekşi M, Şahin S, Kural A, Sipahi M, Kargı T, Bitkin A, Taşçı Aİ. Effect of access sheath diameter used in percutaneous nephrolithotomy on renal function: a prospective randomized study. Urolithiasis 2024; 52:100. [PMID: 38922347 DOI: 10.1007/s00240-024-01582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
We aimed to determine the effect of the access sheath diameter used in percutaneous nephrolithotomy (PNL) on renal function. We also investigated the predictors of impaired renal function. Data were prospectively collected from patients who underwent PNL from December 2020 to December 2021. The patients were randomized into two groups according to access sheath diameter: Group 1 (22 Fr, n = 44) and Group 2 (28 Fr, n = 44). Relative renal function (RRF) was calculated by technetium-99 m dimercaptosuccinic acid scintigraphy, and glomerular filtration rate (GFR) was calculated by diethylenetriamine pentaacetic acid scintigraphy. A difference of 5% or more in RRF was considered a significant functional change. Preoperative and postoperative Kidney Injury Molecule-1 (KIM-1) levels were measured. Preoperative demographic data and stone characteristics were similar between the groups. There were also no statistically significant differences between the groups in terms of scar development, changes in RRF, GFR, or KIM-1/creatinine (Cr) (p > 0.05). Significant deterioration in RRF was detected in a total of six (6.8%) patients, three in each group. The factors predicting loss of function were analyzed by regrouping the patients without loss of function as Group A (n = 82) and those with loss as Group B (n = 6). Only stone volume was statistically significant in multivariate analysis (p = 0.002). Access sheath diameter had no significant effect on renal function after PNL. However, the stone volume was found to independently correlate to a loss of renal function after PNL.
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Affiliation(s)
- Deniz Noyan Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
| | - Mithat Ekşi
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Alev Kural
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
- Department of Biochemistry, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Murat Sipahi
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
- Department of Nuclear Medicine, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Taner Kargı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Alper Bitkin
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Memmos D, Sarafidis P, Alexandrou ME, Theodorakopoulou M, Anastasiadis A, Mykoniatis I, Dimitriadis G, Hatzichristou D. The effect of standard percutaneous nephrolithotomy, miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery on biomarkers of renal injury: a randomized clinical trial. Clin Kidney J 2023; 16:2216-2225. [PMID: 37915926 PMCID: PMC10616431 DOI: 10.1093/ckj/sfad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 11/03/2023] Open
Abstract
Background Observational studies on the association of endourological procedures with renal parenchymal damage are lacking. This randomized trial examined the effect of standard percutaneous nephrolithotomy (sPCNL) in comparison with miniaturized-PCNL (mini-PCNL) and retrograde intrarenal surgery (RIRS) for nephrolithiasis treatment on novel biomarkers of renal injury. Methods Seventy-five patients were randomized in a 1:1:1 ratio to receive sPCNL, mini-PCNL and RIRS for nephrolithiasis. The ratios of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukin-18 (IL-18) normalized for urinary creatinine (Cr) were calculated from urine samples collected at baseline (2-h preoperatively) and at 2-, 6-, 24- and 48-h postoperatively. Two-way mixed analysis of variance (ANOVA) for repeated measurements was used to evaluate the effects of type of procedure and time on studied biomarkers. Results Between baseline and 2-h postoperatively, no significant differences were observed in NGAL/Cr changes between sPCNL [median (interquartile range) 9.46 (4.82-14.9)], mini-PCNL [12.78 (1.69-25.24)] and RIRS [6.42 (2.61-23.90)] (P = .902). Similarly, no between-group differences were observed for KIM-1/Cr (P = .853) and IL-18 (P = .980) at 2 h, and all biomarkers at any time-point postoperatively. Within-groups, significant increases from baseline were noted for NGAL/Cr (sPCNL, P < .001; mini-PCNL, P < .001; RIRS, P = .001), KIM-1/Cr and IL-18/Cr at 2 h; progressively lower increases from baseline were noted in all groups for KIM-1/Cr and IL-18/Cr at 6-, 24- and 48-h postoperatively. As such, a significant effect of time but not of type of procedure was evidenced with two-way mixed ANOVA. No significant between-group differences were observed in acute kidney injury incidence and complications. Conclusions The endourological procedures under study are associated with similar patterns of early tubular injury, detected by novel biomarkers, which is largely reduced within 48 h and no changes in glomerular function.
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Affiliation(s)
- Dimitrios Memmos
- 1st Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Mykoniatis
- 1st Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- 1st Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Qin Z, Li H, Jiao P, Jiang L, Geng J, Yang Q, Liao R, Su B. The value of urinary interleukin-18 in predicting acute kidney injury: a systematic review and meta-analysis. Ren Fail 2022; 44:1717-1731. [PMID: 36259446 PMCID: PMC9586591 DOI: 10.1080/0886022x.2022.2133728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims The aim of this study was to systematically review relevant studies to evaluate the value of urinary interleukin-18 (uIL-18) in predicting acute kidney injury (AKI). Methods A comprehensive search of PubMed, Medline, Embase, and Cochrane Library was conducted for literature published up to 1 August 2022. Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) was applied to assess the literature quality. Then, relevant data were extracted from each eligible study and a random-effects regression model was utilized to pool sensitivity, specificity, and construct summary receiver operating characteristic (SROC) and area under curve (AUC). Results Twenty-six studies with 7183 patients were enrolled and relevant information was extracted. The estimated sensitivity and specificity of uIL-18 in the diagnosis of AKI were 0.64 (95% confidence interval (CI): 0.54–0.73) and 0.77 (95%CI: 0.71–0.83), respectively. The pooled diagnostic odds ratio (DOR) was 6.08 (95%CI: 3.63–10.18), and the AUC of uIL-18 in predicting AKI was 0.78 (95%CI: 0.74–0.81). Subgroup analysis showed that uIL-18 in pediatric patients was more effective in predicting AKI than in adults (DOR: 7.33 versus 5.75; AUC: 0.81 versus 0.77). Conclusions Urinary IL-18 could be a relatively good biomarker with moderate predictive value for AKI, especially in pediatric patients. However, further research and clinical settings are still needed to validate our findings.
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Affiliation(s)
- Zheng Qin
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Hancong Li
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Pengcheng Jiao
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Luojia Jiang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Jiwen Geng
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Ruoxi Liao
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med + Biomaterial Institute of West China Hospital/West China School of Medicine of Sichuan University, Chengdu, China
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Ecer G, Sönmez MG, Aydın A, Topçu C, Alalam HNI, Güven S, Balasar M. Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study. Urolithiasis 2022; 50:625-633. [PMID: 35802150 DOI: 10.1007/s00240-022-01345-y2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/24/2022] [Indexed: 05/20/2023]
Abstract
The objective is to compare patients who underwent retrograde intrarenal surgery with and without a ureteral access sheath (UAS) using kidney injury molecule-1 (KIM-1) levels. We also examined the difference in kidney damage between standard and dual lumen UAS. Sixty patients diagnosed with kidney stones and scheduled for RIRS were randomized into three groups: RIRS without UAS (Group 1), 11Fr/13Fr Boston scientific Navigator™ UAS (Group 2), and 11Fr/13Fr dual lumen ClearPetra™ UAS (Group 3). Data were prospectively collected in consecutive patients. Urine KIM-1/Cr levels were measured preoperatively, at postoperative 4 h, and on a postoperative day 14. Stone size, location, number, pre- and postoperative stent use, operation time, stone-free rate (SFR), post-ureteroscopic lesion scale (PULS) grade, hospitalization duration, and complications were recorded. There was no significant difference in demographical parameters and preoperative KIM-1/Cr levels among the groups. Postoperative 4th-hour urine KIM-1/Cr levels were higher in patients without UAS than patients with UAS (1.86, 0.67, 0.63 Groups 1, 2, 3, respectively). In comparing group 1 with groups 2 and 3 separately, Group 1 had a statistically significantly higher value than both groups (p = 0.002, p = 0.001, respectively). According to UAS type, there was no significant difference between groups 2 and 3. The use of UAS during RIRS has been shown to reduce kidney injury in the evaluation with KIM-1. Different UAS types on kidney injury and which one can protect the kidneys more during the procedure; will be elucidated by prospective randomized studies involving larger patient groups and UAS types.
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Affiliation(s)
- Gökhan Ecer
- Urology Department, Konya State Hospital, Konya, Turkey.
| | - Mehmet Giray Sönmez
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Arif Aydın
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Cemile Topçu
- Biochemistry Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | | | - Selçuk Güven
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Mehmet Balasar
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
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Ecer G, Sönmez MG, Aydın A, Topçu C, Alalam HNI, Güven S, Balasar M. Comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study. Urolithiasis 2022; 50:625-633. [PMID: 35802150 PMCID: PMC9263800 DOI: 10.1007/s00240-022-01345-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
The objective is to compare patients who underwent retrograde intrarenal surgery with and without a ureteral access sheath (UAS) using kidney injury molecule-1 (KIM-1) levels. We also examined the difference in kidney damage between standard and dual lumen UAS. Sixty patients diagnosed with kidney stones and scheduled for RIRS were randomized into three groups: RIRS without UAS (Group 1), 11Fr/13Fr Boston scientific Navigator™ UAS (Group 2), and 11Fr/13Fr dual lumen ClearPetra™ UAS (Group 3). Data were prospectively collected in consecutive patients. Urine KIM-1/Cr levels were measured preoperatively, at postoperative 4 h, and on a postoperative day 14. Stone size, location, number, pre- and postoperative stent use, operation time, stone-free rate (SFR), post-ureteroscopic lesion scale (PULS) grade, hospitalization duration, and complications were recorded. There was no significant difference in demographical parameters and preoperative KIM-1/Cr levels among the groups. Postoperative 4th-hour urine KIM-1/Cr levels were higher in patients without UAS than patients with UAS (1.86, 0.67, 0.63 Groups 1, 2, 3, respectively). In comparing group 1 with groups 2 and 3 separately, Group 1 had a statistically significantly higher value than both groups (p = 0.002, p = 0.001, respectively). According to UAS type, there was no significant difference between groups 2 and 3. The use of UAS during RIRS has been shown to reduce kidney injury in the evaluation with KIM-1. Different UAS types on kidney injury and which one can protect the kidneys more during the procedure; will be elucidated by prospective randomized studies involving larger patient groups and UAS types.
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Affiliation(s)
- Gökhan Ecer
- Urology Department, Konya State Hospital, Konya, Turkey.
| | - Mehmet Giray Sönmez
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Arif Aydın
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Cemile Topçu
- Biochemistry Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | | | - Selçuk Güven
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | - Mehmet Balasar
- Urology Department, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
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6
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Impact of retrograde intrarenal surgery on biomarkers that are associated with renal parenchyma injury, a preliminary study. World J Urol 2022; 40:841-847. [PMID: 35066638 DOI: 10.1007/s00345-021-03909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The primary objective of this preliminary study was to assess the changes in concentration of biomarkers, which indicate renal injury, after RIRS. MATERIALS AND METHODS Within this prospective study, we included 21 patients with nephrolithiasis requiring treatment with RIRS. From each patient, blood and urine samples were taken at fixed intervals before and after RIRS. Kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein 1 (MCP-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), calbindin, albumin, clusterin, gluthation S-transferase-π (GST-π), beta-2-microglobulin (B2M), osteopontin, cystatin c, and trefoil-factor-3 (TFF3) were measured in urine. Creatinine, cystatin c and uric acid were analyzed in the blood samples. RESULTS A significant increase of the biomarkers clusterin, GST-π, B2M, NGAL and cystatin c was observed after RIRS. However, the biomarkers gradually normalized during the first 14 postoperative days. The parameters surgery time, cumulative stone volume, and BMI did not significantly influence the biomarker concentrations. In the case of GST-π and NGAL a significant positive, yet minuscule effect of age was observed. CONCLUSIONS With our study, we identified 5 out of 12 assessed renal injury biomarkers that showed a significant increase after RIRS. The increase was only temporary and all markers normalized within 14 days. Further studies are needed to determine the clinical value of these identified markers to assess the long-term impact of intrarenal pressure elevation during RIRS.
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Effects of dexmedetomidine on immune function, renal function and inflammatory factors of patients undergoing percutaneous nephrolithotomy under general anesthesia. Exp Ther Med 2021; 21:406. [PMID: 33692837 PMCID: PMC7938444 DOI: 10.3892/etm.2021.9837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
The present study was designed to determine the effects of dexmedetomidine on immune function, renal function and inflammatory factors in patients undergoing percutaneous nephrolithotomy under general anesthesia. A total of 177 patients with kidney calculi who underwent percutaneous nephrolithotomy in The Second Affiliated Hospital of Fujian Medical University were enrolled, in which 91 patients were treated with dexmedetomidine during surgery (research group) and 86 patients were not sedated during surgery (control group). The vital signs, renal function, inflammatory factors and immune function during surgery between the two groups were compared. Patients in the research group showed improved vital signs, renal function, inflammatory factors and immune function compared with the control group (P<0.05), and also experienced a significantly shorter hospitalization time (P<0.001). Therefore, the present results suggested that with a relatively high safety profile, use of dexmedetomidine for sedation can effectively protect renal and immune functions, and reduce the inflammatory response of patients during percutaneous nephrolithotomy. Thus, dexmedetomidine may have be potentially applied in clinical practice.
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8
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Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm.
Methods
In this prospective study, data of 60 consecutive patients underwent mini-PNL (n = 31) or RIRS (n = 29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared.
Results
The mean stone size was significantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p = 0.02). The mean postoperative NGAL levels were 45.6 ± 12.4 and 48.1 ± 13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically significant for both groups (p: 0.01). The difference between the two groups for mean postoperative NGAL measurements was not statistically significant (p = 0.47). The SFR was significantly higher in the mini-PNL group (96.7% vs. 79.3%, p = 0.04). The complication rates were similar for the two groups (p = 0.99). The mean duration of operation was 48.2 ± 22.5 min in the mini-PNL group and 62.6 ± 18.1 min in the RIRS group (p = 0.03). The median duration of hospitalization was 1 day for both groups.
Conclusions
In patients with renal stones < 3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option.
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Mykoniatis I, Sarafidis P, Memmos D, Anastasiadis A, Dimitriadis G, Hatzichristou D. Are endourological procedures for nephrolithiasis treatment associated with renal injury? A review of potential mechanisms and novel diagnostic indexes. Clin Kidney J 2020; 13:531-541. [PMID: 32905259 PMCID: PMC7467591 DOI: 10.1093/ckj/sfaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
Nephrolithiasis is one of the most common urological conditions with a huge socio-economic impact. About 50% of recurrent stone-formers have just one lifetime recurrence and >10% of patients present with a high recurrent disease requiring subsequent and sometimes multiple surgical interventions. The advent of new technology has made endourological procedures the pinnacle of stone treatment, including procedures like percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery and miniaturized PCNL procedures. Researchers have primarily focused on comparisons with respect to stone-free rates, procedure parameters and post-operative complications. However, the effect of these three procedures on renal function or indexes of renal injury has not been sufficiently examined. This was only reported in a few studies as a secondary objective with the use of common and not the appropriate and detailed renal parameters. This review presents current literature regarding the use of novel and highly predictive biomarkers for diagnosing acute kidney injury, discusses potential mechanisms through which endourological procedures for renal stone treatment may affect renal function and proposes areas with open questions where future research efforts in the field should focus.
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Affiliation(s)
- Ioannis Mykoniatis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Memmos
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Hatzichristou
- First Department of Urology, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chirackal RS, Jayachandran M, Wang X, Edeh S, Haskic Z, Perinpam M, Halling TM, Mehta R, Rivera ME, Lieske JC. Urinary extracellular vesicle-associated MCP-1 and NGAL derived from specific nephron segments differ between calcium oxalate stone formers and controls. Am J Physiol Renal Physiol 2019; 317:F1475-F1482. [PMID: 31461349 DOI: 10.1152/ajprenal.00515.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Randall's plaque (RP; subepithelial calcification) appears to be an important precursor of kidney stone disease. However, RP cannot be noninvasively detected. The present study investigated candidate biomarkers associated with extracellular vesicles (EVs) in the urine of calcium stone formers (CSFs) with low (<5% papillary surface area) and high (≥5% papillary surface area) percentages of RP and a group of nonstone formers. RPs were quantitated via videotaping and image processing in consecutive CSFs undergoing percutaneous surgery for stone removal. Urinary EVs derived from cells of different nephron segments of CSFs (n = 64) and nonstone formers (n = 40) were quantified in biobanked cell-free urine by standardized and validated digital flow cytometer using fluorophore-conjugated antibodies. Overall, the number of EVs carrying surface monocyte chemoattractant protein (MCP)-1 and neutrophil gelatinase-associated lipocalin (NGAL) were significantly lower in CSFs compared with nonstone former controls (P < 0.05) but did not differ statistically between CSFs with low and high RPs. The number of EVs associated with osteopontin did not differ between any groups. Thus, EVs carrying MCP-1 and NGAL may directly or indirectly contribute to stone pathogenesis as evidenced by the lower of these populations of EVs in stone formers compared with nonstone formers. Validation of EV-associated MCP-1 and NGAL as noninvasive biomarkers of kidney stone pathogenesis in larger populations is warranted.
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Affiliation(s)
- Robin S Chirackal
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Muthuvel Jayachandran
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.,Division of Hematology Research, Mayo Clinic, Rochester, Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Xiangling Wang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Samuel Edeh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Zejfa Haskic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Majuran Perinpam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Ramila Mehta
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Fiorentino M, Castellano G, Kellum JA. Differences in acute kidney injury ascertainment for clinical and preclinical studies. Nephrol Dial Transplant 2018; 32:1789-1805. [PMID: 28371878 DOI: 10.1093/ndt/gfx002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/03/2017] [Indexed: 12/25/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common clinical condition directly associated with adverse outcomes. Several AKI biomarkers have been discovered, but their use in clinical and preclinical studies has not been well examined. This study aims to investigate the differences between clinical and preclinical studies on AKI biomarkers. Methods We performed a systematic review of clinical and preclinical interventional studies that considered AKI biomarkers in enrollment criteria and/or outcome assessment and described the main differences according to their setting, the inclusion of biomarkers in the definition of AKI and the use of biomarkers as primary or secondary end points. Results In the 151 included studies (76 clinical, 75 preclinical), clinical studies have prevalently focused on cardiac surgery (38.1%) and contrast-associated AKI (17.1%), while the majority of preclinical studies have focused on ether ischemia-reperfusion injury or drug-induced AKI (42.6% each). A total of 57.8% of clinical studies defined AKI using the standard criteria and only 19.7% of these studies used AKI biomarkers in the definition of renal injury. Conversely, the majority of preclinical studies defined AKI according to the increase in serum creatinine and blood urea nitrogen, and 32% included biomarkers in that definition. The percentage of both clinical and preclinical studies with biomarkers as a primary end point has not significantly increased in the last 10 years; however, preclinical studies are more likely to use AKI biomarkers as a primary end point compared with clinical studies [odds ratio 2.31 (95% confidence interval 1.17-4.59); P = 0.016]. Conclusion Differences between clinical and preclinical studies are evident and may affect the translation of preclinical findings in the clinical setting.
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Affiliation(s)
- Marco Fiorentino
- Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, Pittsburgh, USA.,Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Giuseppe Castellano
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Mohamed Ali OS, Elshaer SS, Anwar HM, Zohni MSELD. Relevance of cystatin-C, N-acetylglucosaminidase, and Interleukin-18 with the diagnosis of acute kidney injury induced by cadmium in rats. J Biochem Mol Toxicol 2017; 31. [DOI: 10.1002/jbt.21968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Ola Sayed Mohamed Ali
- Department of Biochemistry, Faculty of Pharmacy (Girls); Al Azhar University; Cairo Egypt
| | - Shereen Saeid Elshaer
- Department of Biochemistry, Faculty of Pharmacy (Girls); Al-Azhar University; Cairo Egypt
| | - Hend Mohamed Anwar
- Department of Biochemistry; National Organization for Drug Control and Research; Giza Egypt
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13
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Urinary biomarkers in the early detection and follow-up of tubular injury in childhood urolithiasis. Clin Exp Nephrol 2017; 22:133-141. [PMID: 28653226 DOI: 10.1007/s10157-017-1436-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND To investigate relationships among urinary biomarkers [kidney injury molecule-1 (KIM-1), N-acetyl-β-glucosaminidase (NAG)], neutrophil gelatinase-associated lipocalin (NGAL) levels and renal tubular injury in childhood urolithiasis. METHODS Seventy children [36 girls, mean age: 7.3 ± 5.0 years (0.5-18.2)] with urolithiasis/microlithiasis and 42 controls [18 girls, mean age: 8.5 ± 3.8 years (0.9-16.2)] were included in this multicenter, controlled, prospective cohort study. Patients were evaluated three times in 6-month intervals (0, 6 and 12th months). Anthropometric data, urinary symptoms, family history and diagnostic studies were recorded. Urine samples were analyzed for metabolic risk factors (urinary calcium, uric acid, oxalate, citrate, cystine, magnesium, and creatinine excretion), and the urinary KIM-1, NAG, and NGAL levels were measured. RESULTS Stones were mostly located in the upper urinary system (82.9%), and six patients (8.6%) had hydronephrosis. Thirty patients (42.9%) had several metabolic risk factors, and the most common metabolic risk factor was hypocitraturia (22.9%). Urinary KIM-1/Cr, NAG/Cr and NGAL/Cr ratios were not significantly different between patients and controls. Furthermore, no significant changes in their excretion were shown during follow-up. Notably, the urinary KIM-1/Cr, NAG/Cr, and NGAL/Cr levels were significantly higher in children under 2 years of age (p = 0.011, p = 0.006, and 0.015, respectively). NAG/Cr and NGAL/Cr ratios were significantly increased in patients with hydronephrosis (n = 6, p = 0.031 and 0.023, respectively). CONCLUSIONS The results of this study suggest that none of the aforementioned urinary biomarkers (KIM-1, NAG and NGAL levels) may be useful for the early detection and/or follow-up of renal tubular injury and/or dysfunction in childhood urolithiasis.
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14
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El-Nahas AR, Taha DE, Ali HM, Elshal AM, Zahran MH, El-Tabey NA, El-Assmy AM, Harraz AM, Moawad HE, Othman MM. Acute kidney injury after percutaneous nephrolithotomy for stones in solitary kidneys. Scand J Urol 2017; 51:165-169. [PMID: 28351191 DOI: 10.1080/21681805.2017.1295103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys. METHODS The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI. RESULTS The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively). CONCLUSIONS The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.
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Affiliation(s)
- Ahmed R El-Nahas
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Diaa-Eldin Taha
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Hussien M Ali
- b Department of Anesthesia , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Ahmed M Elshal
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Mohamed H Zahran
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Nasr A El-Tabey
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Ahmed M El-Assmy
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Ahmed M Harraz
- a Department of Urology , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Hazem E Moawad
- b Department of Anesthesia , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
| | - Mahmoud M Othman
- b Department of Anesthesia , Urology and Nephrology Center, Mansoura University , Mansoura , Egypt
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15
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Patel N, Cohen BR, De S, Kartha G, Li I, Sarkissian C, Calle J, Monga M. Continuation of Renin-Angiotensin-Aldosterone Inhibitors Does Not Impact Renal Function Among Patients Undergoing Percutaneous Nephrolithotomy. J Endourol 2017; 31:577-582. [PMID: 28340535 DOI: 10.1089/end.2017.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In the perioperative period, renin-angiotensin-aldosterone system (RAAS) inhibitors may result in cardiovascular and renal functional changes. We sought to determine the acute and chronic renal functional and blood pressure effects of continuing or withdrawing angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS This was a retrospective review of all patients undergoing PCNL at our institution from 2002 to 2013. Patients on either an ACE-I and/or ARB who received an ACE-I and/or ARB during their surgical hospitalization were matched based on sex, age, and body mass index to patients who had their medication withheld during the postoperative period. The two groups were compared. RESULTS A total of 2784 patients underwent PCNL during the study period. At the time of PCNL, 15.2% (423/2784) of patients and 6.5% (181/2784) were prescribed an ACE-I and an ARB, respectively. Fifty-nine percent (248/423) of patients on an ACE-I and 66.9% (121/181) on an ARB received their medication during their postoperative hospitalization. There was no significant difference in average length of stay (2 days vs 2 days), perioperative change in glomerular filtration rate, glomerular filtration rate (GFR) (-0.50 mL/min/1.73 m2 vs -2.34 mL/min/1.73 m2, p = 0.267), change in GFR at 1 month postoperatively (-4.63 mL/min/1.73 m2 vs -5.90 mL/min/1.73 m2, p = 0.748), or change in GFR at 1 year (-2.08 mL/min/1.73 m2 vs -0.13 mL/min/1.73 m2, p = 0.267) between patients who received vs withheld their medication during the postoperative stay. CONCLUSION It is safe to continue RAAS inhibitors in patients undergoing PCNL during their operative hospitalization.
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Affiliation(s)
- Nishant Patel
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Benjamin R Cohen
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shubha De
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ganesh Kartha
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ina Li
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carl Sarkissian
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Juan Calle
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manoj Monga
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
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Amini E, Pishgar F, Hojjat A, Soleimani M, Asgari MA, Kajbafzadeh AM. The role of serum and urinary carbohydrate antigen 19-9 in predicting renal injury associated with ureteral stone. Ren Fail 2016; 38:1626-1632. [PMID: 27756162 DOI: 10.1080/0886022x.2016.1202732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study was designed to evaluate the role of urinary and serum carbohydrate antigen 19-9 (CA19-9) as a biomarker in the assessment of patients with ureteral stone. A total of 38 patients with ureteral stone and hydronephrosis who underwent transurethral lithotripsy (TUL) (Group A) and 24 age-matched healthy controls (Group B) were evaluated in this study. Urinary and serum CA19-9 concentrations were measured in group A patients before TUL as well as 4 and 8 weeks following the operation. Urinary and serum CA19-9 concentrations were also measured in group B participants. Median concentration of urinary and serum CA19-9 was 34.0 and 15.0 kU/L in group A patients and 16.1 and 5.3 kU/L in group B, respectively (p < 0.001). Medians of CA19-9 concentration in urine and serum reduced to 12.5 and 4.5 kU/L 8 weeks after TUL (p < 0.001). Following successful TUL and hydronephrosis resolution, a significant decline was detected in serum and urinary CA19-9. We also noted that duration of ureteral obstruction was associated with serum and urinary CA19-9 concentrations, suggesting the potential role of this marker in predicting renal damage associated with urinary tract obstruction and determining the appropriate timing of interventions.
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Affiliation(s)
- Erfan Amini
- a Uro-Oncology Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Farhad Pishgar
- a Uro-Oncology Research Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Asal Hojjat
- b Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Soleimani
- c Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Majid Ali Asgari
- c Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Abdol-Mohammad Kajbafzadeh
- b Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences , Tehran , Iran
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