Assessment of the nephroprotective efficacy of steroid therapy by analyzing concentrations of new markers of the renal damage at the extracorporeal remote shock wave lithotripsy in children

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Abstract

BACKGROUND: for several decades, the remote shock wave lithotripsy was a leading technique for surgical management of concretions in the upper urinary tract. The key reason for its wide spread was minimal invasion combined with high efficiency. However, it has been proven that after each lithotripsy session the acute kidney injury develops. Currently, there is no any curative strategy aimed to protect the renal parenchyma from pathological impacts of shock wave energy.

AIM: to evaluate Prednisolone nephroprotective efficacy after analysing dynamic levels of biomarkers of kidney damage during the remote shock wave lithotripsy in children.

METHODS: 108 children with urolithiasis after a session of remote shock wave lithotripsy were enrolled in the study. All patients were divided into two groups of 54 participants in each. Participants from the control group were treated according to the standard protocol. Participants from the studied group, in addition to the traditional therapy, were prescribed Prednisolone orally at dosage 0.5 mg/kg once a day for 2 days before the session of external shock wave lithotripsy and 2 hours before the surgery. Urine and blood samples were taken from all patients: before surgery, 45 minutes and 24 hours after it. Biomarker concentration was assessed in all samples.

RESULTS: The biomarker concentration in the urine differed statistically significantly in patients of the studied group and of the control one. The most pronounced changes were noted 45 minutes after the surgery. A statistically significant concentration increase of all studied biomarkers was revealed in patients from the control group. In children from the studied group, concentration of kidney damage molecule 1 did not change, and lipocalin concentration associated with neutrophil gelatinase, tissue inhibitor of metalloproteinase 2 and hepatic forms of fatty acid binding protein increased statistically significantly less than in patients of the control group. Interleukin 18 concentration in the blood serum of patients from the control group increased statistically significantly, while in patients from the studied group - statistically insignificantly.

CONCLUSION: A statistically significant decrease in the concentration of studied biomarkers, and, consequently, less degree of renal damage in the studied group, can promote implementation of the glucocorticoid therapy as a medical support during the external shock wave lithotripsy in children.

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About the authors

Sergey N. Zorkin

National Medical Research Center for Children’s Health

Email: zorkin@nczd.ru
ORCID iD: 0000-0002-4038-1472
SPIN-code: 4762-8837

MD, Dr. Sci. (Medicine), Professor

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 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
SPIN-code: 9310-2660

MD

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 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), Professor

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

Akexey N. Tsygin

National Medical Research Center for Children’s Health

Email: tsygin@nczd.ru
ORCID iD: 0000-0001-6301-9313
SPIN-code: 7948-5065

MD, Dr. Sci. (Medicine), Professor

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

Marina A. Snowskaya

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, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

Anastasia M. Milovanova

National Medical Research Center for Children’s Health

Email: milovanova@nczd.ru
ORCID iD: 0000-0003-1615-2044
SPIN-code: 8260-5227

MD, Cand. Sci. (Medicine)

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

Dmitriy S. Shakhnovsky

National Medical Research Center for Children’s Health

Email: shakhnovski@nczd.ru
ORCID iD: 0000-0003-2883-2493
SPIN-code: 4946-0848

MD

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

Rimir R. Bayazitov

National Medical Research Center for Children’s Health

Email: krasik17@yandex.ru
SPIN-code: 5506-6828

MD, Cand. Sci. (Medicine)

Россия, 2 bldg 1 Lomonosovsky prospekt, 119991 Moscow

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Supplementary files

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2. Fig. 1. The effect of extracorporeal shock wave lithotripsy on the urine neutrophil gelatinase-associated lipocalin concentration: NGAL — neutrophil gelatinase-associated lipocalin.

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3. Fig. 2. The effect of extracorporeal shock wave lithotripsy on the urine kidney injury molecule 1 concentration: KIM-1 — kidney injury molecule 1.

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4. Fig. 3. The effect of extracorporeal shock wave lithotripsy on the urine tissue inhibitor of metalloproteinases 2 concentration: TIMP-2 — tissue inhibitor of metalloproteinases 2.

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5. Fig. 4. The effect of extracorporeal shock wave lithotripsy on the urine liver-type fatty acid binding protein concentration: L-FABP — liver-type fatty acid binding protein.

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6. Fig. 5. The effect of extracorporeal shock wave lithotripsy on the serum interleukin 18 concentration: IL-18 — interleukin 18.

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Copyright (c) 2024 Zorkin S.N., Nikulin O.D., Semikina E.L., Tsygin A.N., Snowskaya M.A., Milovanova A.M., Shakhnovsky D.S., Bayazitov R.R.

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