Markers of renal dysfunction after percutaneous nephrolithotripsy.
Authors:   the Urology Department of the Clinical Hospital «Clinical Hospital of the Russian Railways-Medicine named Semashko», Rogachikov V.V. ,   Moscow, Russia, Sevryukov F.A. ,   the E.V. Shakhov Department of Urology, Privolzhsky Research Medical University; Nizhny Novgorod, Russia, Kudryashov A.V. ,   the Urology Department of the Clinical Hospital «Clinical Hospital of the Russian Railways-Medicine named Semashko», PhD student at the E.V. Shakhov Department of Urology, Privolzhsky Research Medical University; Moscow, Russia, Ignatiev D.N. ,   the Urology Department of the Clinical Hospital «Clinical Hospital of the Russian Railways-Medicine named Semashko» PhD student at the E.V. Shakhov Department of Urology, Privolzhsky Research Medical University; Moscow, Russia, Sotnikov A.S. ,   the Urology Department of the Clinical Hospital «Clinical Hospital of the Russian Railways-Medicine named Semashko»; Moscow, Russia
Published: November 2024

Introduction. Kidney stones (KS) is a common disease and occupies a significant place in urological practice. The incidence of KS is actively growing in industrialized countries. Modern technologies make it possible to carry out mini-cut interventions, reducing the risks of complications of standard techniques. However, an increase in the duration of procedures can lead to perfusion-pressor complications and overheating of the irrigated fluid. Acute kidney injury (AKI) during intraoperative intervention worsens the prognosis of rehabilitation and affects the dynamics of morbidity. For reliable and timely diagnosis of renal dysfunction, research is being conducted to develop new AKI biomarkers. The aim of this study was to study the effect of various percutaneous access methods on the level of acute renal injury in patients with urolithiasis. Materials and methods. The study was conducted on the basis of the Center of Urology, Nephrology and Lithotripsy of the N. A. Semashko from 2022 to 2023. The results of surgical treatment of 21 patients with nephrolithiasis were studied. The patients were divided into two groups depending on the percutaneous access method: standard PNL (28 Ch) and mini-PNL (16 Ch). The work used modern biomarkers of renal damage, such as Cystatin C, NGAL, KIM-1 and IL-18 in the postoperative period. Results. An increase in the concentration of Cystatin C and NGAL after PNL prevailed in group 1, which is associated with the release of biomarkers by tubules from a larger area of damaged renal parenchyma. Changes in KIM-1 levels in the postoperative period were greater in group 2, which is associated with the greatest ischemic damage to renal tissue. A decrease in IL-18 levels in group 2 is associated with less damage to the renal tubules and the absence of inflammatory reactions. It was found out that after 48 hours all AKI biomarkers undergo regression. Conclusions. The results of the study showed that the level of renal damage was higher in patients who underwent standard PNL, compared with those who used mini-PNL. This indicates that the use of mini-PNL may reduce the risk of acute renal injury in patients with urolithiasis.