Potential biomarkers for the early detection of acute kidney injury after percutaneous nephrolithotripsy

Abstract

This study aims to investigate the role of urinary biomarkers in the determination of the potential risks of renal parenchymal tubular damage in adult patients who underwent percutaneous nephrolithotomy (PNL) with the indication of renal stone. A randomized and prospective controlled study was performed between June and December 2013. We enrolled 29 consecutive patients with renal calculi42 cm and who underwent PNL, as well as 47 healthy control subjects. Urine samples, including 2 h before surgery, 2 and 24 h after surgery were collected from the patient group. Freshly voided urine samples were collected from the control group. Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-glucosaminidase (NAG), and liver-type fatty acid binding protein (LFABP) levels were measured from these urine samples. The mean KIM-1/Cr value that measured 24 h after the operation was statistically significant, higher than its preoperative (preop) level (p ¼ 0.045). A significant difference was detected between the mean preop and postoperative (postop) 24 h NAG/Cr values (p50.001). Also, postop 24 h NGAL/Cr levels were statistically significant, higher than its preop levels (p ¼ 0.013). According to the comparison of preop and postop levels, an increase in LFABP/Cr values secondary to surgical intervention was observed without any statistically significant difference. Besides the LFABP/Cr levels do not change after percutaneous kidney surgery, KIM-1/Cr, NAG/Cr, and NGAL/Cr levels increase postop period, especially at 24 h. Further studies with a larger series and repeated measurements should be performed to clarify if they can be used to demonstrate renal damage after percutaneous surgery or not.

Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study

“…The primary end point of the study was to compare the changes of NGAL levels and sample size calculation was performed according to this parameter. In the previous studies NGAL levels showed an increase of 50% for PNL cases 6 and 30% for ureterorenoscopy [5] postoperatively. Sample size calculation revealed that 28 patients were needed for each group to determine a difference of 20% increase in NGAL levels with an alpha value of 0.05 and power level of 80%.…”

“…AKI develops following stone surgery and NGAL has been shown to be a good marker for detection of the level of AKI [5,6,9]. Renal parenchymal injury mainly causes the elevation of NGAL in the PNL cases and increased intrarenal pressure is blamed for AKI in RIRS cases [5,6]. In a recent study, Daggulli et al evaluated the changes in NGAL levels in PNL cases and reported a doubled NGAL/creatinine ratio in the postoperative measurement.…”

“…In a recent study, Daggulli et al evaluated the changes in NGAL levels in PNL cases and reported a doubled NGAL/creatinine ratio in the postoperative measurement. Different from our study, the authors used NGAL/ creatinine ratio for standardization and performed PNL cases in prone position with 30 Fr dilation [6]. We included only patients with preoperative creatinine levels in normal ranges for standardization and therefore, did not use the NGAL/creatinine ratio.…”

“…Determination of the possible amount of kidney injury is important and biomarkers such as Neutrophil gelatinase-associated lipocalin (NGAL), Kidney injury molecule-1 (KIM-1), liver fatty acid binding protein (L-FABP) have been reported to be used for this purpose. NGAL has been studied as a biomarker of acute kidney injury (AKI) related to urinary stones [4] and NGAL levels were shown to increase after both PNL and ureterorenoscopy [5,6]. PNL has the potential to cause AKI by renal parenchymal penetration [6] and RIRS results in elevated intrarenal pressures and therefore AKI [5].…”

The role of serum and urinary carbohydrate antigen 19-9 in predicting renal injury associated with ureteral stone

“…Few studies have evaluated the role of biomarkers in early detection of renal injury. 13 CA19-9 which is elevated in patients with obstructive hydronephrosis might be a potential marker in determining renal injury associated with ureteral obstruction in patients with ureteral stones.…”