Assessment Of Plasma Homocysteine As A Marker Of Acute Renal Injury In Patients Undergoing Extracorporeal Shock Wave Lithotripsy (Eswl) For Renal Stone Disease – One Year Cross Sectional Study

Abstract

Background and Objectives Extracorporeal Shock wave lithotripsy (ESWL) commonly used procedure for treating upper urinary tract stones may result in complications of acute renal failure. The present study was aimed to assess plasma homocysteine (HCy) as a marker of acute renal injury in patients undergoing ESWL for renal stone disease and compare the same with other markers i.e. serum creatinine and serum high sensitive C reactive protein (hs-CRP). Methodology This one year cross-sectional study was done in the Department of General Surgery and Department of Urology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2015 to December 2015. 64 patients undergoing ESWL were investigated for plasma tHCy, serum creatinine and hs-CRP 24 hours before and after ESWL procedure. Results Majority of the patients were males (71.88%). The male to female ratio was 2.55:1. Most of the patients were aged between 31 to 40 years and 41 to 50 years (31.25% each) and mean age was 40.88±10.46 years. Most of the patients presented with pain (96.87%). Left renal calculus was noted in 53.13% of the patients while right renal calculus was noted in 46.88% of the patients. Post ESWL, AKI developed in 56.25% of the patients. Post ESWL mean plasma tHCy levels were significantly high in patients with AKI (21.01±7.67 vs16.93±7.44 μmol/L; p=0.036) compared to those who did not develop AKI. The mean change in plasma HCy levels in patients with AKI was significantly high (10.90±4.87 vs 6.85±6.06 μmol/L; p=0.004). The post ESWL mean serum creatinine levels were significantly high in patients with AKI (1.59±0.44 vs 1.32±0.29 mg/dL; p=0.006). The mean change in serum creatinine levels in patients with AKI was significantly high (0.90±0.25 vs 0.28±0.24 mg/dL; p<0.001). The post ESWL mean hs-CRP levels were comparable in patients with AKI and those who did not develop AKI (p=0.120). 72.22% of the patients with AKI has significant rise of s.hs-CRP (≥2 fold of baseline) level after ESWL which is the only insult on kidney in 24 hours. Conclusion and interpretation Plasma total homocystine, serum hs-CRP and serum creatinine can be used as renal injury markers following ESWL in patients with renal stone disease.