Abstract
BACKGROUND: for several decades, the remote shock wave lithotripsy was a leading technique for surgical management of concretions in the upper urinary tract. The key reason for its wide spread was minimal invasion combined with high efficiency. However, it has been proven that after each lithotripsy session the acute kidney injury develops. Currently, there is no any curative strategy aimed to protect the renal parenchyma from pathological impacts of shock wave energy.
AIM: to evaluate Prednisolone nephroprotective efficacy after analysing dynamic levels of biomarkers of kidney damage during the remote shock wave lithotripsy in children.
METHODS: 108 children with urolithiasis after a session of remote shock wave lithotripsy were enrolled in the study. All patients were divided into two groups of 54 participants in each. Participants from the control group were treated according to the standard protocol. Participants from the studied group, in addition to the traditional therapy, were prescribed Prednisolone orally at dosage 0.5 mg/kg once a day for 2 days before the session of external shock wave lithotripsy and 2 hours before the surgery. Urine and blood samples were taken from all patients: before surgery, 45 minutes and 24 hours after it. Biomarker concentration was assessed in all samples.
RESULTS: The biomarker concentration in the urine differed statistically significantly in patients of the studied group and of the control one. The most pronounced changes were noted 45 minutes after the surgery. A statistically significant concentration increase of all studied biomarkers was revealed in patients from the control group. In children from the studied group, concentration of kidney damage molecule 1 did not change, and lipocalin concentration associated with neutrophil gelatinase, tissue inhibitor of metalloproteinase 2 and hepatic forms of fatty acid binding protein increased statistically significantly less than in patients of the control group. Interleukin 18 concentration in the blood serum of patients from the control group increased statistically significantly, while in patients from the studied group - statistically insignificantly.
CONCLUSION: A statistically significant decrease in the concentration of studied biomarkers, and, consequently, less degree of renal damage in the studied group, can promote implementation of the glucocorticoid therapy as a medical support during the external shock wave lithotripsy in children.