輸尿管鏡碎石及氣球擴張手術會導致急性腎臟傷害及遠端腎小管受傷
黃鶴翔¹、劉展榮^1
1成大醫院泌尿部

Ureterorenoscopic lithotripsy and balloon dilation cause acute kidney injury and distal renal tubule damage

Ho-Shiang Huang, Chan-Jung Liu¹

Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan

Purpose: Ureterorenoscopy (URS) is thought to be a safe and effective procedure for treatment of stones, but the ideal duration and indication for post-URS stenting is controversial. This prospective study was conducted to evaluate whether URS dilatation or lithotripsy would cause AKI (evaluated by urine NGAL, neutrophil gelatinase associated lipocalin) and renal tubular damage (evaluated by urine GST and GST, glutathione S-transferase) and whether 2-week DBJ stenting could prevent these insults.

Materials and Methods: In this study, the study population consisted of 207 patients (women = 80 and men = 141). The mean patient age was 53.8 years (range 21 – 85 years). Four groups were included: two study groups and two control groups. After diagnosis by intravenous urography (IVU) or non-contrast-enhanced CT scan, patients with unilateral obstructive uropathy were enrolled into the ureteral stricture group (group 1) or ureteral stone group (group 2).

Results: URS induced increased uNGAL on Days 1 and 14 in both groups, and only elevated u-GST levels were noted on Day 14 after URSL in group 2. On Day 14, the difference between low-grade (H0+H1) and high-grade (H2+H3) readings was significant in group 1 (p < 0.001) rather than group 2 (p = 0.150). By multivariate logistic regression analysis, age, baseline eGFR, and stone size > 1.0 cm were associated with complete recovery of hydronephrosis after URS on Day 14. baseline eGFR ≧ 60 subgroup of group 2 suffered more AKI (uNGAL) than eGFR < 60 subgroup; whereas, the changes in uNGAL, u-GST and u-GST had no significant difference between the two subgroups in group 1. URS-related AKI had no significant difference between stone ≦ 1 cm and > 1 cm subgroup. u-GST was significantly higher in stone > 1 cm subgroup when compared to ≦ 1 cm subgroup, but both had no significant difference when compared with the baseline. u-GST was significantly lower in stone ≦ 1 cm subgroup when compared to > 1 cm subgroup, but still significant higher than the baseline in the same subgroup. In conclusion, URS laser lithotripsy or balloon dilatation can result in AKI and renal tubular damage on Day 14 after URS, though post-URS DBJ stenting was performed in every patient.