Evaluation of adrenomedullin levels in renal parenchyma subjected to extracorporeal shockwave lithotripsy

Variations in Nitric Oxide and Endothelin Serum Levels in Extracorporeal Shock Wave Lithotripsy-Treated Patients

Introduction:

Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (ET), while nitric oxide (NO) has special role in several pathological renal conditions.

Aim:

The aim of this study to examine the presence, character, and degree of changes in NO and ET levels in the serum of extracorporeal shock wave lithotripsy (ESWL)-treated patients with nephrolithiasis.

Patients and Methods:

This study included a total of 60 patients that were divided in two groups: Group I (n = 24), in which a total of 2000SWs were administered; 0–2 units; (0.5 units per each 500SWs), and Group II (n = 36), in which a total of 4000SWs were administered; 0–4 units; (0.5 units per each 500SWs).

Results:

In the Group I median NO serum concentration increased in relation to pretreatment levels (39.04 ± 8.29 μmol/L) specifically 30 min, 60 min, and 24 h following the treatment (39.11 ± 12.60), (41.80 ± 6.89), and (46.33 ± 9.03), where concentration growth after 24 h was statistically significant P < 0.01. The NO serum concentration in the Group II increased in relation to pretreatment levels (38.90 ± 10.33 μmol/L) after 30 min (48.71 ± 30.09), 60 min (54.57 ± 39.76), and 24 h (97.95 ± 72.07). The NO concentration increase after 60 min and 24 h is statistically significant, respectively, P < 0.03 and P < 0.0001.

Conclusion:

NO and ET serum levels are changing under the influence of ESWL, and that the NO and ET changes are directly correlated with the number of administered shock waves and administered energy.

Evaluating ESWL-induced renal injury based on urinary TNF-α, IL-1α, and IL-6 levels

Extracorporeal shockwave lithotripsy (ESWL) has dramatically changed the treatment of urinary lithiasis and has been the first treatment option for the majority of patients for more than two decades. Despite its significant benefits, it induces acute renal injury that extends from the papilla to the outer cortex. We evaluated the severity of the inflammatory response to ESWL by measuring the urinary excretion of the cytokines TNF-α, IL-1α, and IL-6. The study included 21 selected patients and 14 control subjects. All patients underwent the same ESWL procedure (2,500 shockwaves at 100 shockwaves/min and 0.039 J from the lithotripter). Urine TNF-α, IL-1α, and IL-6 levels were measured using standard ELISA kits. In the study population (patients and controls), we did not detect TNF-α in the urine samples. The levels of both IL-1α (2.5 pg/ml) and IL-6 (3.8 pg/ml) measured before ESWL were not significantly different from the control group (2.5 and 5.2 pg/ml, respectively; p > 0.05). Twenty-four hours after ESWL, in contrast to IL-1α (4 pg/ml), urine IL-6 (19.7 pg/ml) increased significantly (p < 0.05). Fourteen days after ESWL, IL-1α increased to 5 pg/ml, while IL-6 (7 pg/ml) decreased to the control level. Urine cytokine levels may be used to evaluate the inflammatory response to ESWL. After ESWL, IL-6 levels increased in the early phase, while IL-1α levels increased later. These two markers may be used to measure the severity of inflammation. In contrast to IL-1α and IL-6, urine TNF-α excretion was not increased by ESWL. We believe that the inflammatory response to ESWL can be detected by the urinary excretion of IL-1α for up to 14 days.