Assessment of the dynamics of concentration of biomarkers of acute kidney injury in remote shock wave lithotripsy in children

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Abstract

BACKGROUND: For several decades, remote shock wave lithotripsy has been considered a universally recognized gold standard for the treatment of upper urinary tract concrements. Despite its noninvasiveness, each lithotripsy session causes acute kidney injury which cannot be reliably assessed with traditional indicators used in nephrourology. Currently, new modern indicators found in the urine and serum are thought to be more informative biomarkers. In this paper, we investigated the effectiveness of some of them for possible potentials in the diagnostics of acute kidney injury in remote lithotripsy.

AIM: To evaluate changes in acute kidney injury biomarkers during remote shock wave lithotripsy in children.

MATERIALS AND METHODS: 54 children with urolithiasis, who had a session of remote shock wave lithotripsy, were enrolled in the study. In all patients, samples of urine and blood serum were taken three times for assessing biomarkers concentration: before lithotripsy session, after 45 min and after 24 h.

RESULTS: Statistically significant changes in the concentration of all urine biomarkers (NGAL, L-FABP, TIMP-2, calbindin-D, KIM-1) were registered at the basal level and 45 min after the procedure. A number of markers studied by us in the blood serum showed more significant changes 24 h after the procedure (IL-18, TNF-α). Although IGFBP-1 concentration increased slightly after 45 min, this change was not statistically significant (p <0.781). The level of cystatin C did not increase after lithotripsy.

CONCLUSION: The performed analysis of changes in biomarkers concentration has revealed a sufficiently high informative value of biomarkers in assessing the degree of acute kidney injury during remote lithotripsy in children. It also allows to suggest that the studied biomarkers may be promising indicators characterizing such an injury.

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About the authors

Sergey N. Zorkin

National Medical Research Center for Children’s Health

Email: zorkin@nczd.ru
ORCID iD: 0000-0002-2731-5008
SPIN-code: 4762-8837

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow

Oleg D. Nikulin

National Medical Research Center for Children’s Health

Author for correspondence.
Email: dr.nikulin.oleg@yandex.ru
ORCID iD: 0000-0003-3640-9994
Россия, Moscow

Elena L. Semikina

National Medical Research Center for Children’s Health

Email: semikina@nczd.ru
ORCID iD: 0000-0001-8923-4652
SPIN-code: 3647-4967

MD, Dr. Sci. (Medicine)

Россия, Moscow

Marina A. Snovskaya

National Medical Research Center for Children’s Health

Email: snows@inbox.ru
ORCID iD: 0000-0002-5263-6743
SPIN-code: 9899-1095

MD, Cand. Sci. (Medicine)

Россия, Moscow

Dmitriy S. Shakhnovskiy

National Medical Research Center for Children’s Health

Email: shahnovskii_dmit@mail.ru
ORCID iD: 0000-0003-2883-2493
SPIN-code: 4946-0848
Россия, Moscow

Rimir R. Bayazitov

National Medical Research Center for Children’s Health

Email: krasik17@yandex.ru
ORCID iD: 0000-0002-2809-1894
Россия, Moscow

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2. Fig. 1. Remote shock wave lithotripsy impact at NGAL concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.026, Friedman’s criterion.

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3. Fig. 2. Remote shock wave lithotripsy impact at L-FABP concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p=0.003, Friedman’s criterion.

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4. Fig. 3. Remote shock wave lithotripsy impact at TIMP-2 concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.001, Friedman’s criterion.

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5. Fig. 4. Remote shock wave lithotripsy impact at calbindin-D concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.001, Friedman’s criterion.

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6. Fig. 5. Remote shock wave lithotripsy impact at KIM-1 concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.001, Friedman’s criterion.

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7. Fig. 6. Remote shock wave lithotripsy impact at IL-18 concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p=0.037, Friedman’s criterion.

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8. Fig. 7. Remote shock wave lithotripsy impact at TNF-a concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.001, Friedman’s criterion.

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9. Fig. 8. Remote shock wave lithotripsy impact at IGFBP-7 concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p=0.724, Friedman’s criterion.

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10. Fig. 9. Remote shock wave lithotripsy impact at cystatin-C concentration in the urine: 1st checkpoint — before the study; 2nd checkpoint — 45 min after the procedure; 3rd checkpoint — 24 hours after the procedure. The data are presented as a median, p <0.001, Friedman’s criterion.

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Copyright (c) 2023 Zorkin S.N., Nikulin O.D., Semikina E.L., Snovskaya M.A., Shakhnovskiy D.S., Bayazitov R.R.

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