A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy‐induced renal injury

Abstract

Objective To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)‐induced renal injury. Patients and Methods A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase‐associated lipocalin (uNGAL) were estimated after 2–4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast‐enhanced magnetic resonance imaging was performed before ESWL, and at 2–4 h and 1 week after ESWL to compare changes in renal perfusion. Results Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. Conclusions Losartan was found to protect the kidney against ESWL‐induced renal injury by significantly decreasing post‐ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post‐ESWL renal obstruction.

Prevalence of hypertension and diabetes after exposure to extracorporeal shock-wave lithotripsy in patients with renal calculi: a retrospective non-randomized data analysis

“…Limitations of our study are the moderate questionnaire response rate and the unavailable information regarding hypertension or diabetes at time-point of SWL. Additionally, currently used lithotripter, newer settings (e.g., ramping [ 20 , 21 ]) and co-current medications [ 22 ] have been discussed to reduce damage to the kidneys but were not used in this study. Nevertheless, in the absence of prospective data from larger cohorts with an appropriate follow-up, our study is a unique and valuable opportunity to study long-term adverse effects.…”

Novel Therapies for Acute Kidney Injury

“… 88 Micronutrient supplementation (including selenium) failed to provide a benefit in patients who underwent extracorporeal shockwave lithotripsy, cardiac surgery, major trauma, or subarachnoid hemorrhages. 89 , 90 In contrast, a randomized, controlled trial by Ghorbani et al. in 2013 found that cancer patients who received cisplatin therapy had a decreased incidence of AKI when pretreated with selenium.…”

Acute kidney injury in pediatrics: an overview focusing on pathophysiology

“…Selenium supplementation is proposed to reduce cellular oxidative damage in animal models. However, human data are ambiguous [101,102]. Propofol is associated with increased kidney protection when compared to sevoflurane.…”