Clinical significance of the biomarker KIM-1 IN assessing kidney injury after contact ureterolithotripsy

Belyi L.E., Klochkov A.V., Klochkov V.V., Shmyrin A.G.

1) Ulyanovsk State University, Russia, Ulyanovsk, Russia; 2) Ulyanovsk Regional Clinical Center for Specialized types of Medical Care named after Honored Doctor of Russia E.M. Chuchkalov, Ulyanovsk, Russia

Relevance. Transurethral ureterolithotripsy (TULT) is considered as a first-line treatment method in patients with ureteral stones. TULT is associated with its high efficacy and low incidence of complications. However, the effect of TULT on kidney function has not been sufficiently studied. The aim was to explore the possibility of using the biomarker KIM-1 (Kidney Injury Molecule-1) in the assessment of kidney injury after TULT in patients with occlusive ureteral calculi. Materials and methods of research. The clinical data of 28 patients with ureteral stones who underwent surgery were analyzed. Before and after TULT serum creatinine levels were determined, glomerular filtration rate (GFR) was calculated, KIM-1 was quantified in urine, and dopplerography of renal blood flow was performed with the calculation of the resistance index in the interlobular arteries of the kidneys (Ri). The size, density of the stone and its localization in the ureter were determined using computed tomography. A day after TULT, computed tomography was performed repeatedly to identify residual stones and assess the position of the ureteral catheter. Results. The average size of the stones was 46,9±5,0 mm2, and the duration of the TULT was 31,9±5,5 minutes. The size of the renal pelvis significantly decreased in the postoperative period (17,3±1,6 mm before surgery and 11,4±0,9 mm after, p<0,05). The urinary excretion level of KIM-1 was significantly higher in patients with occlusive ureteral stones than in patients of the control group with kidney stones without urinary stasis. Different pathogenetic scenarios of the course of the postoperative period were observed. A significant decrease in Ri and a simultaneous significant increase in the concentration of KIM-1 in urine were found in 10 patients a day after TULT, 6 hours after removal of the ureteral catheter. The reсovery of urine outflow from a kidney that has recently been in a state of ischemia leads to normalization of renal hemodynamics and is accompanied by increased urinary excretion of KIM-1. This phenomenon is obviously related with the «washing» of the renal tubules. In the remaining 18 patients, Ri did not decrease and there was no increase in the concentration of KIM-1 in urine. In our opinion, there is a continuation of obstructive uropathy due to local swelling of the ureteral mucosa. The duration of the endoscopic intervention and the size of the concretion were not factors, determining the severity of renal hemodynamic disorders and damage to the renal tubulointerstitium. Multidirectional changes in Ri in the postoperative period were accompanied by a significant decrease in serum creatinine and an increase in GFR. This makes it impossible to use these indicators to assess kidney injury after surgery. Conclusion. A study of the urinary excretion level of KIM-1 before and after TULT in combination with a measurement of renal hemodynamics makes it possible to assess kidney injury. There are potential possibilities for using KIM-1 as a tool for determining the duration of upper urinary drainage after TULT.

Keywords

About the Authors

Corresponding author: L.E. Belyi – Dr.Sci.(Med), professor of department of hospital surgery, anesthesiology, reanimatology, urology, traumatology, orthopedics, Ulyanovsk State University, Ulyanovsk, Russia; e-mail: lbely@yandex.ru

Similar Articles