Ahmed R El-Nahas1, Mohamed M Elsaadany1, Diaa-Eldin Taha1, Ahmed M Elshal1, Mohamed Abo El-Ghar2, Amani M Ismail3, Essam A Elsawy4, Hazem H Saleh4, Ehab W Wafa5, Amira Awadalla6, Tamer S Barakat1, Khaled Z Sheir1. 1. Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 2. Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 3. Department of Clinical Pathology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 4. Department of Microbiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 5. Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 6. Department of Molecular Biology Laboratory, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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.
RCT Entities:
OBJECTIVE: To evaluate the protective effects of selenium with vitamins A, C and E (seleniumACE, 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, seleniumACE; 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.
Authors: Ana Flávia Lima Ruas; Gabriel Malheiros Lébeis; Nicholas Bianco de Castro; Vitória Andrade Palmeira; Larissa Braga Costa; Katharina Lanza; Ana Cristina Simões E Silva Journal: Pediatr Nephrol Date: 2021-11-30 Impact factor: 3.651
Authors: Christian Daniel Fankhauser; Nilufar Mohebbi; Josias Grogg; Alexander Holenstein; Qing Zhong; Thomas Hermanns; Tullio Sulser; Johann Steurer; Poyet Cédric Journal: Int Urol Nephrol Date: 2018-05-21 Impact factor: 2.370