Treatment of renal calculi by lithotripsy: minimising short-term shock wave induced renal damage by using antioxidants

Al-Awadi, Khaleel, Kehinde, Elijah O., Loutfi, Issa, Mojiminiyi, Olusegan A., Al-Hunayan, Adel, Abdul-Halim, Hamdy, Al-Sarraf, Ahmed, Memon, Anjum and Abraham, Matthew P. (2008) Treatment of renal calculi by lithotripsy: minimising short-term shock wave induced renal damage by using antioxidants. Urological Research, 36 (1). ISSN 1434-0879

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Abstract

Treatment with extracorporeal shock wave lithotripsy (ESWL), the preferred method of treating kidney stones <3 cm in size, has been shown to induce silent and often self-limiting acute and chronic lesions in the kidneys and adjacent organs. We conducted a randomized clinical trial to determine whether ESWL produces ischaemia and reperfusion injury in the kidneys and whether oral administration of antioxidants reduces the degree of short-term renal injury in patients treated with ESWL. The study included 120 patients with renal stones (1–3 cm in size) treated with ESWL. The patients were divided into three groups—patients in group A (n = 39) served as a control group and were not given any antioxidants; patients in group B (n = 41) were given two capsules of antioxidants “Nature Made r” 2 h before ESWL, and 2 and 8 h after ESWL; and patients in group C (n = 40) were given two capsules of the antioxidants 2 and 8 h after ESWL. Double ‘J’ stents were inserted in patients before treatment with ESWL. Blood and urine samples were obtained from all patients just before the start of treatment with ESWL, and at 2 and 24 h and on 7th and 28th day after ESWL. Serum levels of malondialdehyde (MDA), α-tocopherol, cholesterol, albumin and ascorbic acid, and α-tocopherol/cholesterol ratio were determined. Urinary levels of albumin and β2 microglobulin were also determined as measures of renal tubular injury. At 24 h after ESWL, patients given antioxidants (groups B + C) had significantly reduced mean serum concentration of MDA (P < 0.001); higher levels of serum ascorbic acid (P < 0.001) and serum albumin (P < 0.001); lower α-tocopherol/cholesterol ratio, lower urinary albumin and β2 microglobulin levels compared with patients who did not receive antioxidants (group A). These findings suggest that treatment with ESWL generates free radicals through ischaemic/reperfusion injury mechanism, and that oral administration of antioxidant may protect these patients from short term renal injury caused by ESWL.

Item Type: Article
Keywords: Renal calculi - Shock waves - Renal injury - Antioxidants - Humans
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine > R Medicine (General)
Depositing User: Caroline Brooks
Date Deposited: 23 Jun 2009
Last Modified: 13 Mar 2017 11:57
URI: http://sro.sussex.ac.uk/id/eprint/2206
Google Scholar:12 Citations

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