Renal protective effect of N -acetylcysteine with stepwise ramping voltage against extracorporeal shock wave lithotripsy
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UROLOGY - ORIGINAL PAPER
Renal protective effect of N‑acetylcysteine with stepwise ramping voltage against extracorporeal shock wave lithotripsy‑induced renal injury: a prospective randomized trial Esam A. E. Desoky1 · Ahmed M. Sakr1 · Mohamed Alhefnawy2 · Mohamed Omran1 · Mohamed M. H. Abdalla1 · Ashraf S. Shahin1 · Maged M. Ali1 Received: 25 May 2020 / Accepted: 20 July 2020 © Springer Nature B.V. 2020
Abstract Purpose To evaluate the role of combination of N-acetylcysteine with stepwise ramping voltage in renal protection against the ischemic, vascular and oxidative effects of extracorporeal shock wave lithotripsy. Patients and methods A prospective randomized trial on 164 adult patients scheduled for ESWL for single renal stones. Patients with radio-lucent stones, diabetes, hypertension, febrile UTI, and preoperative albuminuria were excluded from the study. Patients were randomized into one of four groups. Group A patients received maximal fixed voltage of ESWL. Group B patients received stepwise ramping voltage of ESWL. Group C patients received fixed maximal voltage with N-acetylcysteine (NAC) 600 mg/bid from 48 h before to 24 h after the procedure. Group D patients received gradual ramping voltage with NAC. Urinary β2-microglobulin, 24 h albumin and N-acetyl-β-d-glucosaminidase/creatinine ratio at 1 day and 5 days postESWL and the stone free rate at 2 weeks were measured. Results Group D was the only group that showed no significant difference pre and post ESWL in urinary albumin, β2microglobulin and N-acetyl-β-d-glucosaminidase/creatinine ratio. Post hoc analysis revealed no significant difference between group B and group C in albumin, β2-microglobulin N-acetyl-β-d-glucosaminidase/creatinine ratio, but both of them had significantly lower levels than group A and significantly higher levels than group D. There was no statistically significant difference between all groups in the stone free rate at 2 weeks. Conclusion N-acetylcysteine protects the kidney against ESWL-induced renal injuries especially if combined with stepwise ramping voltage. Keywords ESWL · NAC · Ramping · Micro-albumin · β2-microglobulin
Introduction Urolithiasis is a common health problem worldwide. Its exact pathophysiological basis of formation is not yet clear, as there are different types of it and being too complex to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11255-020-02580-1) contains supplementary material, which is available to authorized users. * Maged M. Ali [email protected] 1
Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
2
be understood. Sometimes, it may lead to progressive renal morbidity. Therefore, in many cases, stone elimination should be done as soon as possible. The appropriate modality of treatment should be considered to provide the highest efficacy with the lowest morbidity [1, 2]. Throughout the last decades, extracorporeal shockwave
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