Göger Yunus Emre, Özkent Mehmet Serkan, Topçu Cemile, Atıcı Ahmet, Sönmez Mehmet Giray, Balasar Mehmet, Gürbilek Mehmet
Department of Urology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey.
Department of Urology, Konya City Hospital, Konya, Turkey.
Urol Int. 2022;106(5):446-454. doi: 10.1159/000517883. Epub 2021 Jul 30.
Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery.
We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement.
The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0-1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively).
KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.
肾损伤分子-1（KIM-1）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是目前在急性肾损伤（AKI）中有效应用的主要新型生物标志物。这些生物标志物的水平尤其在肾毒性和缺血性肾损伤的早期会升高。在本研究中，我们旨在探讨NGAL和KIM-1生物标志物在急性单侧梗阻性结石病（AUOSD）患者内镜手术管理中对肾功能有效评估的临床重要性。
我们前瞻性纳入了2018年1月至2019年12月因AUOSD接受内镜手术的患者。测量患者术前、术后第4小时和术后第7天的尿KIM-1和NGAL值。根据结石的位置和大小、肾积水程度、手术持续时间、并发症以及输尿管支架置入情况对患者进行评估。
该研究共纳入50例患者。术后第4小时尿KIM-1/Cr和尿NGAL/Cr比值高于其他时间（p < 0.001）。此外，我们发现2级及以上肾积水患者的尿KIM-1/Cr和尿NGAL/Cr比值在统计学上高于0-1级肾积水患者（分别为p < 0.001和p: 0.042）。此外，术前尿KIM-1值为1.24 ng/mL预测肾积水存在的灵敏度为78%，特异度为63%。当将尿KIM-1和NGAL结果与手术时间（手术时长）、结石大小和位置、血清肌酐（sCr）值以及输尿管镜检查后损伤量表分级进行比较时，差异无统计学意义。术后第7天，置入输尿管支架的患者NGAL/Cr和KIM-1/Cr比值在统计学上更高（分别为p: 0.03和p: 0.004）。
即使sCr正常，KIM-1和NGAL也可用于我们对AUOSD患者肾功能的评估。此外，这些生物标志物可以预测肾积水的存在。它有助于确定手术治疗时间，并在治疗后对置入输尿管支架的患者进行随访时提供信息。
