A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy-induced renal injury
| Autor: | Ehab W. Wafa, Ahmed R. El-Nahas, Diaa-Eldin Taha, Essam A. El-Sawy, Mohamed M. Elsaadany, Tamer S. Barakat, Amira Awadalla, Khaled Z. Sheir, Hazem Hamed Saleh, Ahmed M. Elshal, Mohamed E. Abo El-Ghar, Amani M. Ismail |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology Urinary system 030232 urology & nephrology Ascorbic Acid urologic and male genital diseases Kidney Antioxidants Losartan law.invention 03 medical and health sciences Selenium 0302 clinical medicine Randomized controlled trial law Lithotripsy medicine Humans Vitamin E Vitamin A business.industry Vitamins medicine.disease Calcium Channel Blockers Surgery medicine.anatomical_structure Verapamil 030220 oncology & carcinogenesis Albuminuria Wounds and Injuries Kidney stones Drug Therapy Combination Female medicine.symptom business Perfusion Angiotensin II Type 1 Receptor Blockers medicine.drug |
| Zdroj: | BJU international. 119(1) |
| ISSN: | 1464-410X |
| Popis: | To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury.A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion.Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased.Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction. |
| Databáze: | OpenAIRE |
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