Urinary obstruction depresses erythropoiesis which recovers after parenchyma-saving surgery but not SWL

Abstract

We tested the hypotheses that chronic human urinary obstruction impairs the renal regulation of the red blood cell (RBC) production and compared the chronic outcome of relief of obstruction between parenchyma-saving surgery and extracorporeal lithotripsy (SWL). We measured RBC count and serum erythropoietin (Epo) concentration before and 3 months after relief of urinary obstruction in 60 patients treated with pyelolithotomy, ureterolithotomy or ureteroscopy and in 62 patients treated with SWL. Compared with 333 healthy controls, at baseline, patients scheduled for parenchyma-saving surgery had lowered RBC count [9.9% (6.9-13.1); 95% confidence interval] in case of males and 17.7% (14.2-21.4) in case of females; minor depression in RBC count was also observed in female patients scheduled for SWL. Epo serum levels were mildly reduced in SWL patients and halved in parenchyma-saving surgery group. At 3 months following relief of obstruction in 50 operated patients without recurrent or residual stone, Epo levels almost doubled, becoming normal, while RBC count and haemoglobin concentration increased for 6.1% (3.8-8.8) and 8.8% (6.1-10.6). In contrast, in 49 SWL patients only minor, bidirectional responses to treatment were observed. We conclude that obstructive uropathy is associated with clinically relevant effects on erythropoiesis, which is reversed after relief of obstruction by parenchyma-saving surgery that saves the renal parenchyma.

Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014–2016)

“…4,25 A study showed that obstructive uropathy was associated with clinically relevant effects on erythropoiesis in human patients. 26 Moreover, anaemia seems to be common after ureteral surgery due to haemorrhage during the procedure, erythropoietin production defect after kidney injury due to ongoing CKD and prolonged obstruction or surgical procedures. 25,27 Finally, fluid resuscitation is also associated with hospital-acquired anaemia, and institution of fluid therapy lowers PCV.…”

Preventive effect of pomegranate juice on ESWL-related renal damage in patients with kidney stones

“…Eterović et al showed that ESWL caused a transient increase in EPO levels independent of hemoglobin levels. This increase is attributed to intrarenal microcirculatory disorders resulting in tissue hypoxia (25). In an animal study on pigs, Willis et al established 3 groups: ESWL only (Group 1); ESWL after verapamil (Group 2); and sham (Group 3).…”