Assessment of plasma homocysteine as a marker of acute renal injury in patients undergoing extracorporeal shock wave lithotripsy for renal stone disease - 1-year cross-sectional study

Abstract

Context: Extracorporeal shock wave lithotripsy (ESWL) commonly used procedure for treating upper urinary tract stones may result in acute kidney injury (AKI) with release of biomarkers. Association of plasma total homocysteine (tHCy), serum high-sensitivity C-reactive protein (hs-CRP), and serum creatinine with renal dysfunction and their role as acute renal injury markers is to be assessed. Aim: The study aims to assess plasma tHCy as a marker of AKI in patients undergoing ESWL for renal stone disease and compare the same with other markers, i.e., serum creatinine and serum hs-CRP. Setting and Design: One-year cross-sectional study at a tertiary care teaching hospital. Subjects and Methods: Sixty-four patients undergoing ESWL for renal stone disease were investigated for plasma tHCy, serum creatinine, and serum hs-CRP 24 h before and after ESWL procedure. Patients were divided into AKI and non-AKI group. Statistical Analysis: SPSS statistical software, rates, ratios, percentages, and mean ± standard deviation. A P ͳ 0.05 at 95% confidence interval was considered as statistically significant. Results: Following 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 vs. 16.93 ± 7.44 μmol/L; P = 0.036) compared to those who did not develop AKI. The post-ESWL mean serum creatinine levels and mean change were significantly high in patients with AKI. The post-ESWL mean serum hs-CRP levels were comparable in patients with AKI and those who did not develop AKI. However, 72.22% of the patients with AKI had significant rise of serum hs-CRP (≥2-fold of baseline) level following ESWL which was the only insult on kidney in 24 h. Conclusion: Plasma tHcy, Serum hs-CRP, and Serum creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.