Demir E et al, 2014: Immediate and long-term high levels of plasma homocysteine after extracorporeal shock wave lithotripsy in patients with renal stone disease.
Demir E, Izol V, Aridogan IA, Paydas S, Tansug Z, Erken U
Department of Urology, Faculty of Medicine, University of Çukurova, 01330, Adana, Turkey
BACKGROUND: Plasma homocysteine levels increase in patients with chronic renal failure. Numerous studies have demonstrated that kidney
function is one of the most important determinants of plasma total homocysteine (tHcy) concentration. In this study we aimed to evaluate the relationship between tHcy levels and extracorporeal shock wave lithotripsy (ESWL) for patients with renal stones and to see if the change in homocysteine levels continued if renal dysfunction improved. MATERIALS AND METHODS: The study consisted of 20 patients who underwent first-time ESWL for renal stones. Every patient gave 3 blood samples at 24 h before surgery and at 2 days and at 3 months after ESWL for measurement of plasma levels of tHcy, creatinine, vitamin B6, and vitamin B12. RESULTS: The 20 patients (12 male, 8 female) had a mean age of 42.8 ± 11.7 years. tHcy levels showed a statistically significant increase from 9.4 ± 1.4 to 18 ± 4.8 and 11.2 ± 2.1 at 2 days and at 3 months, respectively. Serum creatinine also showed a statistically significant increase compared to baseline at 2 days and at 3 months after ESWL. CONCLUSION: After first-time ESWL, the increase in serum levels of creatinine and tHcy due to renal injury, such as ischemia/reperfusion injury, may be severe and continue for a long period, such as 3 months. According to baseline levels, the increase in homocysteine levels as an indicator of oxidant stress was more severe than the creatinine levels after ESWL for renal stones. Our patients were first-time ESWL patients; however, in patients who undergo EWSL more than once long-term high tHcy levels should also be considered as renal.
Clin Exp Nephrol. 2014 May 28. [Epub ahead of print]
The authors describe their findings but do not explain them in detail. What comes as a surprise is a statistically significant creatinine increase although within the normal range at three months after ESWL. Other authors have shown normalisation of renal function after ESWL even in patients with a solitary kidney (Karlsen et al. Urol Res 1991; 19: 105-115; Kulb et al. J Urol 1986;136:786-788; Zanetti et al. J Urol 1992;148;1011-1014)