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A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy‐induced renal injury
Author(s) -
ElNahas Ahmed R.,
Elsaadany Mohamed M.,
Taha DiaaEldin,
Elshal Ahmed M.,
ElGhar Mohamed Abo,
Ismail Amani M.,
Elsawy Essam A.,
Saleh Hazem H.,
Wafa Ehab W.,
Awadalla Amira,
Barakat Tamer S.,
Sheir Khaled Z.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13667
Subject(s) - medicine , losartan , urology , albuminuria , verapamil , calcium channel blocker , lithotripsy , kidney , surgery , angiotensin ii , calcium , blood pressure
Objective To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE , i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy ( ESWL )‐induced renal injury. Patients and Methods A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL . Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE ; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase‐associated lipocalin ( uNGAL ) were estimated after 2–4 h and 1 week after ESWL . The primary outcome was differences between albuminuria and uNGAL . Dynamic contrast‐enhanced magnetic resonance imaging was performed before ESWL , and at 2–4 h and 1 week after ESWL to compare changes in renal perfusion. Results Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week ( P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL ( P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. Conclusions Losartan was found to protect the kidney against ESWL ‐induced renal injury by significantly decreasing post‐ ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post‐ ESWL renal obstruction.