Nasseh H et al, 2016: Urinary Beta-2Microglobulin: An Indicator of Renal Tubular Damage after Extracorporeal Shock Wave Lithotripsy.
Nasseh H, Abdi S, Roshani A, Kazemnezhad E.
Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran.
Abstract
PURPOSE: This study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damage and the affecting factors by measuring urinary beta2microglobulin (β2M) excretion.
MATERIALS AND METHODS: This is a cross-sectional study conducted on 91 patients with renal stones who underwent ESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure for each patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubular injury.
RESULTS: Mean ± SD urinary beta2-microglobulin values, before and after ESWL were 0.08 ± 0.07 and 0.22 ± 0.71mg/dL respectively, the average difference between which was equal to 0.14 ± 0.07 mg/dL. These figures exhibited a 166.66% rise in the urinary β2M concentration after ESWL which was statistically significant (P < .001). Multivariate analysis showed that hypertension (P = .05) and the history of ESWL (P = .02) were predictive factors of higher post-ESWL urinary beta2-microglobulin excretion.
CONCLUSION: Urinary excretion of beta2-microglobulin increased significantly immediately after ESWL. These changes could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patients with hypertension and a previous history of ESWL the likelihood of this injury is higher than others.
Urol J. 2016 Dec 8;13(6):2911-2915
Comments 1
This is a report on measurements of 2-microglobulin before and after shockwave lithotripsy. The most important conclusion was that hypertension and previous SWL were associated with increased levels of 2-microglobulin. It is not clear if the observation reflects a real tubular injury or only is a response to physiological alterations caused by the treatment. It is for instance noted that increased GFR (seen with hypertension) can overload the mechanism of re-absorption of 2-microglobulin. Affected re-absorption can also be caused by transient vasoconstriction. Unfortunately the measurements were carried out only once immediately after SWL, and the duration of the abnormality is unknown.
Although it is stated that SWL was carried out with 2500 shockwaves at level 3, it is not mentioned which lithotripter that was used.