Assessing the Effects of Using a Ureteral Access Sheath on Kidney Injury in Retrograde Intrarenal Surgery with KIM-1 and NGAL Biomarkers in Urine: A Prospective Cohort Study

Abstract

Objective: This study aimed to investigate the effects of ureteral access sheath (UAS) use in patients undergoing retrograde intrarenal surgery (RIRS) due to kidney stones on postoperative early kidney injury development using urine kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) measurements. Materials and Methods: Thirty patients using UAS (UAS group) and 30 not using UAS (non-UAS group), for whom RIRS was planned, and 30 healthy controls (control group) were included between January and June. Blood urea nitrogen and creatinine in the blood and KIM-1 and NGAL in the urine at the pre-operative and postoperative 24th hours and KIM-1 and NGAL at the postoperative 4th and 24th hours were studied. The same biomarkers were analyzed once in the control group. During follow-up, KIM-1 and NGAL were measured using the enzyme-linked immunosorbent assay method within 6 months. Results: There was no significant difference between the pre-operative KIM-1 and NGAL values and the postoperative 24-h KIM-1 and NGAL values in the UAS group (p>0.05), whereas there was a significant difference in the non-UAS group (p<0.05). The postoperative 24-h KIM-1 and NGAL values were significantly higher in the UAS group than in the non-UAS group (p<0.05). Conclusion: It was determined that more kidney injury developed in the non-UAS group UAS than in the UAS group, especially at the postoperative 24th hour. The use of UAS in RIRS is effective in preventing the development of potential kidney injury.

Keywords

• kidney injury molecule-1
• neutrophil gelatinase-associated lipocalin
• retrograde intrarenal surgery
• ureteral access sheath