Ercan YUVANÇ, Devrim TUĞLU, Serhan GÜR, Tunç OZAN, Üçler KISA, Ertan BATISLAM, Yılmaz Selim ERDAL

SWL tedavisi alan hastalarda böbrek hasarının değerlendirilmesinde özel markırlar: TAS, TOS, PON ve IL-6

Amaç: Şok dalga litotripsi (SWL) prosedürünün böbrek taşları üzerine açık etkinliğinin yanı sıra böbrekler üzerindeki olumsuz etkileri, oksidan/antioksidan denge ile ilişkisi ve bu olumsuz etkinin saptanması için biyomarkır arayışları son yıllarda ilgi çekmektedir. Bu çalışmanın amacı böbrek taşı nedeniyle SWL tedavisi uygulanan hastalarda erken dönemde böbrek hasarı/travma belirlenmesinde biyomarkır olarak toplam antioksidan status (TAS), toplam oksidan status (TOS), oksidatif stres indeksi (OSI), Paraoksonaz-1 (PON-1) ve Interlökin-6 (IL-6) parametrelerinin olası kullanımını araştırmaktır.Gereç ve Yöntemler: Böbrek taşları nedeniyle SWL tedavisi alan 40 hasta işlemden önce ve 2 saat sonra kan örnekleri toplanarak çalışmaya dahil edildiler.Bulgular: SWL tedavisinin oksidan/antioksidan dengesini, IL-6 artışı (P <0,01) ve PON-1 azalması (P = 0.049) ile oksidan parametreler yönünde bozduğu belirlenmiştir. TAS (P = 0.178), TOS (P = 0.175) ve OSI (P = 0.551) parametrelerinde herhangi bir değişiklik gözlenmemiştir. Sonuç: IL-6 ve PON-1'in SWL sonrası erken dönemde renal hasarın belirlenmesinde daha hassas belirteçler olabileceği gösterilmiştir.

Anahtar Kelimeler:

Şok Dalga Litotripsi (SWL), Toplam Antioksidan Status (TAS), Toplam Oksidan Status (TOS), Oksidatif Stres İndeksi (OSI), Paraoksonaz-1 (PON-1), İnterlökin-6 (IL-6)

Clinical use of specific markers TAS, TOS, PON and IL-6 by the evaluation of kidney damage in patients receiving SWL treatment

Aim: Beside efficacy of the shock wave lithotripsy (SWL) procedure, also its negative effects on the kidneys, its relation with the oxidant/antioxidant balance and the search after biomarkers for the detection of this negative effect gained interest in the recent years. The aim of the study is to investigate the possible usage of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), Paraoxonase-1 (PON-1) and Interleukin 6 (IL-6) parameters as biomarkers for renal injury/trauma in the early period by patients undergoing SWL due to kidney stones. Material and Methods: Forty patients receiving SWL therapy due to kidney stones were included to study by collecting their blood samples before and 2 hours after the procedure. Results: It was observed that SWL therapy has deteriorated the oxidant/antioxidant balance in terms of the oxidants by analyzing the increase of IL-6 (P <0,01) and decrease in PON-1 (P = 0.049). There was no change observed in TAS (P = 0.178) and TOS (P = 0.175) and OSI (P = 0.551) parameters. Conclusion: This has shown that IL-6 and PON-1 may be more sensitive markers of renal injury after SWL in early period.

Keywords:

Shock Wave Lithotripsy (SWL), Total Antioxidant Status (TAS), Total Oxidant Status (TOS), Oxidative Stress Index (OSI), Paraoxonase-1 (PON-1), Interleukin-6 (IL-6),

PDF

___

1. Silay MS, Ellison JS, Tailly T, Caione P. Update on Urinary Stones in Children: Current and Future Concepts in Surgical Treatment and Shockwave Lithotripsy. Eur Urol Focus. 2017; 9: 2405-4569.
2. Rajiv G, Deepak D, Naval K et al. Does the type of steinstrasse predict the outcome of expectant therapy? Indian J Urol 2006; 22: 135.
3. Platonov MA, Gillis AM, Kavanagh KM. Pacemakers, implantable cardioverter/defibrillators, and extracorporeal shockwave lithotripsy: evidence-based guidelines for the modern era. J Endourol 2008; 22: 243.
4. Aksoy H, Aksoy Y, Turhan H, Keleş S, Ziypak T, Ozbey I. The effect of shock wave lithotripsy on nitric oxide and malondialdehyde levels in plasma and urine samples. Cell Biochem Funct 2007; 25: 533–36.
5. Tarpey MM, Wink DA, Grisham MB. Methods for detection of reactive metabolites of oxygen and nitrogen: in vitro and in vivo considerations. Am J Physiol Regul Integr Comp Physiol 2004; 286: 431-44.
6. Dundar M, Kocak I, Yenisey C, Serter M, Ozeren B. Urinary and serum cytokine levels in patients undergoing SWL. BJU 2001; 27: 495–99.
7. Chawla LS, Seneff MG, Nelson DR, Williams M, Levy H, Kimmel PL. Elevated plasma concentrations of IL-6 and elevated APACHE II score predict acute kidney injury in patients with severe sepsis. Clin J Am Soc Nephrol 2007; 2: 22-30.
8. Costa LG, Giordano G, Furlong CE. Pharmacological and dietary modulators of paraoxonase 1 (PON1) activity and expression: The hunt goes on. Biochemical Pharmacology 2011; 81: 337-44.
9. Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem 2004; 37: 112–19.
10. Barbosa PV, Makhlouf AA, Thorner D, Ugarte R, Monga M. Shockwave lithotripsy is associated with a higher prevalence of hypertension. Urology. 2011; 78: 22-25.
11. Fischer C, Wöhrle J, Pastor J, Morgenroth K, Senge T. Extracorporeal shockwave lithotripsy induced ultrastructural changes to the renal parenchyma under aspirin use. Electron microscopic findings in the rat kidney. Urologea 2007; 46: 150–55.
12. Lingeman JE, Woods J, Toth PD, Evan AP, McAteer JA. The role of lithotripsy and its side effects. J Urol 1989; 141: 793–77.
13. Clark DL, Connors BA, Evan AP, Willis LR, Handa RK, Gao S. Localization of renal oxidative stress and inflammatory response after lithotripsy. BJU Int 2009; 103: 1562–68.
14. Li X, He D, Zhang L, Cheng X, Sheng B, Luo Y. A novel antioxidant agent, astragalosides, prevents shock wave-induced renal oxidative injury in rabbits. Urol Res 2006; 34: 277–82.
15. Dinarello CA. Proinflammatory cytokines. Chest 2000; 118: 503–8.
16. Tappel AI. Lipid Peroxidation damage to cell components. J Fed Proc 1993; 32: 1870-74.
17. Yilmaz E, Haciislamoglu A, Kisa U, Dogan O, Yuvanc E, Batislam E. Ways in which SWL affects oxidant/antioxidant balance. Urolithiasis 2013; 41: 137-41.
18. Goktas C ,Coskun A, Bicik Z et al. Evaluating ESWL-induced renal injury based on urinary TNF-α, IL-1α, and IL-6 levels Urol Res 2012; 40: 569–73.
19. Nakazawa H, Genka C, Fujishima M. Pathological aspects of active oxygens/free radicals. Jpn J Physiol 1996; 46: 15–32.
20. Dennen P, Altmann C, Kaufman J et al. Urine interleukin-6 is an early biomarker of acute kidney injury in children undergoing cardiac surgery Critical Care 2010; 14: 181.
21. Rieder JM, Nisbet AA, Lesser T et al. IL-6 does not predict current urolithiasis in stone formers. J Endourol 2008; 22: 2373–75.
22. Rhee E, Santiago L, Park E, Lad P, Bellman GC. Urinary IL-6 is elevated in patients with urolithiasis. J Urol 1998; 160: 2284–88.
23. Clark DL, Connors BA, Evan AP, Handa RK, Gao S. Effect of shock wave number on renal oxidative stress and inflammation. BJU Int 2011; 107: 318–22.
24. Greenberg JH, Whitlock R, Zhang WR et al. Interleukin-6 and Interleukin-10 as Acute Kidney Injury Biomarkers after Pediatric Cardiac Surgery Pediatr Nephrol. 2015; 30: 1519–27.
25. de Vries DK, Lindeman JH, Tsikas D et al. Early Renal Ischemia-Reperfusion Injury in Humans Is Dominated by IL-6 Release from the allograft. American Journal of Transplantation 2009; 9: 1574–84.
26. Topsakal C, Kilic N, Ozveren F et al. Effects of prostaglandin E1, melatonin, and oxytetracycline on lipid peroxidation, antioxidant defense system, paraoxonase (PON1) activities, and homocysteine levels in an animal model of spinal cord injury. Spine (Phila Pa 1976) 2003; 28: 1643.
27. Gur M, Aslan M, Yildiz A et al. Paraoxonase and aryl esterase activities in coronary artery disease. Eur J Clin Invest 2006; 36: 779–87.
28. Abraham P, Sugumar E. Enhanced PON1 activity in the kidneys of cyclophosphamide treated rats may play a protective role as an antioxidant against cyclophosphamide induced oxidative stres Arch Toxicol 2008; 82: 237–38.