Soni PK. et al., 2025: "Is oral antioxidant (Vit C & E) helpful in minimizing shock wave induced renal damage? A study from a tertiary care Center from eastern India" A prospective study.
Praveen Kumar Soni 1, Krishnendu Maiti 1, Debansu Sarkar 1
1Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India.
Abstract
Introduction: Extracorporeal shock wave lithotripsy (ESWL) causes trauma to the renal parenchyma. Due to the kidney injury, free radicals are generated, and an inflammatory process develops. Inflammatory markers like interleukin's (IL), C-reactive protein (CRP), and procalcitonin (PCT) are released into the circulation. Antioxidants have the potential to mitigate the effects of the inflammatory process. Our objectives were the measurement of the effect of supplementation with Vit C and Vit E (antioxidants) and their effect on the reduction of CRP and procalcitonin and further kidney damage.
Methodology: There were two groups with 100 patients each. Group A, receiving oral Vitamin E (400 mg twice a day) and oral Vitamin C (500 mg twice a day) beginning 3 days before the lithotripsy and continuing for up to 7 days after the lithotripsy (total of 10 days). Group B served as the control group. Serum levels of CRP and procalcitonin were measured on the day of lithotripsy, day 2, and day 10 post ESWL.
Results: In Group B, CRP and PCT values are statistically significantly elevated as compared to Group A. In Group A, pre-ESWL, day 2 and day 10 CRP values are 1.23, 3.58, and 1.61. In Group B pre-ESWL, day 2 and day 10 CRP values are 1.38, 6.70, and 3.09 (p value < 0.001 in day 2 and 10). In Group A, pre-ESWL, day 2 and day 10 PCT values are 0.41, 1.42, and 0.44. In Group B pre-ESWL, day 2 and day 10 PCT values are 0.36, 3.03, and 1.10 (p value < 0.001 in day 2 and 10).
Conclusion: The serum levels of the inflammatory marker for acute renal injury are decreased when vitamins C and E are taken orally, which can help to minimize kidney damage after lithotripsy for renal stone disease.
Urologia. 2025 May;92(2):216-223. doi: 10.1177/03915603241312963. Epub 2025 Jan 29.
PMID: 39878424
Comments 1
The outstanding advantages of SWL are its non-invasive character and low pain level not requiring general or regional anesthesia. There is, however, a potential risk of kidney trauma. That complication is in most cases mild and of short duration. For patients with reduced renal functions even mild trauma might be more important. Moreover, repeated SWL treatments might cause more extensive kidney injury.
The major cause of kidney or tissue damage is assumed to be associated with production of free radicals that occur during the re-perfusion after ischemia. Accordingly, several antioxidants have been used to counteract the negative effect of oxidative stress. In this report the authors administered vitamin C and vitamin E to 100 patients and compared effects on CRP and procalcitonin (PCT) after SWL with those in 100 patients not given vitamins.
CRP and PCT were increased on days 2 and 10 in both groups but to significantly higher levels in controls. Administration of oral vitamins started 3 days before SWL. It had indeed been interesting to see the effects of loading the patients with vitamins for a longer period before SWL and continued more than 7 days. Nevertheless, vitamins C and E apparently had a favorable effect on oxidative stress and should be considered when kidney tissue injury can be expected and must be avoided.
Hans-Göran Tiselius