Evaluation of Acute Kidney Injury (AKI) Markers in Children Following Extracorporeal Shock Wave Lithotripsy (ESWL): A Prospective Controlled Study

Abstract

Objective: To determine the effect of ESWL on kidney damage in children and use potential AKI biomarker levels as diagnostic indicators. Methods: We enrolled thirty consecutive child patients who underwent ESWL (Group1) with small renal calculi. As a control, thirty child patients (Group 2) with no known urogenital disease and no known history of urologic pathology also participated in this study. Result: The mean age of patients was 7.9±4.3 and 7.5±2.4 years in group 1 and group 2, respectively (p=0.09). The mean stone size was 88.1±65.2 mm² in group 1. Mean levels of KIM 1/Cr were recorded at three times: before ESWL, 2 hours after ESWL, and 24 hours after ESWL. Twenty four hours after surgery, KIM-1/Cr levels increased significantly in urine compared to pre-operative levels (p=0.04).  NGAL/Cr mean levels were not elevated significantly after surgery, but there were significant differences between Group 1 patients and Group 2 patients 24 hours after surgery(p<0.01).  The NAG/Cr levels were higher in the study group than in the control group and increased significantly after the operation.  The mean levels of LFABP /Cr in urinary specimens did not change significantly after ESWL. Conclusion: ESWL is safe and curative for urolithiasis in children, but there is no doubt that ESWL can lead to acute kidney injury. Our data suggests that increased NAG/Cr and KIM 1/Cr levels can help in assessing the amount of damage done to the kidney after ESWL in children.