EVALUATION OF THE NEPHROPROTECTIVE EFFICACY OF STEROID THERAPY BY ANALYZING THE CONCENTRATION OF NEW MARKERS OF RENAL DAMAGE IN REMOTE SHOCK WAVE LITHOTRIPSY IN CHILDREN

Introduction: for several decades, remote shock wave lithotripsy

It is the leading method of surgical treatment of concretions of the upper urinary tract. The key reason for such a wide spread was the minimal degree of invasion combined with high efficiency. However, it has been proven that the outcome of each lithotripsy session is acute kidney injury.  Currently, there is no therapeutic strategy aimed at protecting the renal parenchyma from the pathological effects of shock wave energy

Objective: to evaluate the nephroprotective efficacy of prednisolone based on the analysis of dynamic levels of biomarkers of kidney damage during remote shock wave lithotripsy in children.

Materials and methods: the study included 108 children with urolithiasis, each of whom underwent a session of remote shock wave lithotripsy. In all patients, urine and blood serum were taken three times, before the DUVL session, 45 minutes and 24 hours after surgery, followed by determination of the concentration of biomarkers. The patients were divided into 2 groups of 54 participants each. In the first group, treatment was carried out according to the standard protocol, in the second – in addition to traditional therapy, participants received prednisone 0.5 mg / kg 1 time per day for 2 days before the DUVL session and 2 hours before surgery. 

Results: an analysis of the concentrations of biomarkers in urine in the control groups and those receiving prednisone therapy before the DUVL session showed a significant difference. The most pronounced changes were noted 45 minutes after surgery. In patients of the control group, a statistically significant increase in the level of biomarkers in urine was revealed. At the same time, there was no change in the level of KIM-1 in the children from the study group, and the concentrations of NGAL, TIMP-2 and L-FABP increased slightly, which was statistically significantly lower than the levels of these indicators in the control group. Analyzing the change in the level of IL-18 in blood serum, it was noted that 24 hours after surgery there was a significant increase in IL-18 in patients of the control group, and in the study group there was no significant increase in the concentration of the marker in response to surgery.

Conclusion: a significant decrease in the concentrations of the studied biomarkers, and therefore the degree of DUVL induced renal damage, in the prednisolone group may be the basis for prescribing glucocorticosteroids as medical accompaniment during remote lithotripsy in children.