Role of Vitamin C and E supplementation in reduction of serum level of renal injury marker following shock wave lithotripsy: Prospective single centre experience

Abstract

Introduction:Shock wave lithotripsy has become first line treatment modality for renal calculi due to its noninvasiveness. However, the destructive forces like dispersion of cavitation bubbles can cause trauma to thin-walled vessels and renal parenchyma during fragmentation of the stones. Antioxidants are our first line of defense against oxidative stress. The aim of this study was to investigate whether oral administration of Vitamin C and E help in a reduction of the serum level of inflammatory mediator by serial measurement of high sensitivity C-reactive protein (hs-CRP) and by this reduction in the risk of renal damage.Patients and Methods:A total of 107 subjects were recruited in three groups. Group A served as a control group, and Group B and Group C received oral medication of Vitamin E 800 mg/day and Vitamin C 1000 mg/day respectively, start from 2 days prior the lithotripsy and continued for total 7 days. The level of hs-CRP was used as a mediator of the inflammatory response following lithotripsy and thus for long term renal injury. Serum level of hs-CRP was measured on 2 days prior the lithotripsy and day 2, 7 and 28 after the lithotripsy.Results:Patients who were given either Vitamin C or Vitamin E showed a significant reduction of serum level of hs-CRP when compared to control the group.Conclusion:Oral administration of Vitamin C and E helps in reduction of serum levels of the inflammatory marker for acute renal injury and thus they can be useful in minimizing the kidney injury following lithotripsy for renal stone disease.

The effect of vitamin E supplementation on selected inflammatory biomarkers in adults: a systematic review and meta-analysis of randomized clinical trials

“…Moreover, two eligible articles were published on the same dataset 35,61 , of which the more complete one was included 35 and the other one was excluded 61 . After these exclusions, 33 eligible RCTs remained for inclusion in the current systematic review and meta-analysis ; out of them, 26 studies assessed serum concentrations of CRP 11,[13][14][15][16][17][18][19][20]22,[25][26][27][28][29][30][31][33][34][35]37,38,[40][41][42][43] , 14 studies assessed serum concentrations of IL-6 17,[20][21][22][23][26][27][28][29][30][31]33,37,38 , and 12 studies evaluated serum concentrations of tumor necrosis factor-α (TNF-α) following vitamin E supplementation 12,17,20,…”

“…RCTs included in the current systematic review and meta-analysis are illustrated in Table 1. These RCTs were published between 2000 and 2018 and were from the USA 14,20,27,29,42,43 , Europe 13,15,19,21,22 , Asia 11,18,[23][24][25][26]28,[30][31][32][33][34][35][36][37][39][40][41] , Canada 12 , and Australia 16,17,38 . Four studies were exclusively performed on male subjects 23,24,28,35 and others on both genders.…”

“…Most studies employed a parallel design, while only one study was cross-over 22 . Concerning the type of vitamin E, a total of 27 studies administered α-tocopherol [11][12][13][14][15][17][18][19][20][21][22][23][24][25][26]28,[30][31][32][33][34][35][36][37]39,42,43 , 3 studies administered γ-tocopherol 16,20,29 , and 3 other studies performed the intervention with a combination of different types of tocopherols. In six trials, participants in the vitamin E and control groups received concentrated red grape juice 19 or supplements of α-lipoic acid 26,30 or n-3 fatty acids 14,18,32 in addition to the main intervention.…”

“…Only one study 30 could be considered as a high-quality study with a totally low risk of bias for all domains of the Cochrane Risk of Bias Findings from the systematic review. Among 26 studies assessing the serum concentrations of CRP, 6 studies revealed a significant reducing effect of vitamin E supplementation on serum CRP concentrations 11,34,37,40,42,43 , whereas others found no significant effect. Four trials showed a significant reduction 26,28,30,37 and one study indicated a significant increase in serum IL-6 concentrations 33 following vitamin E supplementation, while others revealed no significant change.…”

“…The effect of vitamin E on serum CRP concentrations. In total, 26 RCTs with a total sample size of 1743 subjects were included in the analysis 11,[13][14][15][16][17][18][19][20]22,[25][26][27][28][29][30][31][33][34][35]37,38,[40][41][42][43] . Combining 36 effect sizes from these studies indicated that vitamin E supplementation, compared with controls, resulted in a significant reduction in serum CRP concentrations [weighted mean difference (WMD) − 0.52, 95% CI − 0.80, − 0.23 mg/L, P < 0.001] (Fig.…”