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Renal protective effect of N-acetylcysteine with stepwise ramping voltage against extracorporeal shock wave lithotripsy-induced renal injury: a prospective randomized trial

  • Urology - Original Paper
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Abstract

Purpose

To evaluate the role of combination of N-acetylcysteine with stepwise ramping voltage in renal protection against the ischemic, vascular and oxidative effects of extracorporeal shock wave lithotripsy.

Patients and methods

A prospective randomized trial on 164 adult patients scheduled for ESWL for single renal stones. Patients with radio-lucent stones, diabetes, hypertension, febrile UTI, and preoperative albuminuria were excluded from the study. Patients were randomized into one of four groups. Group A patients received maximal fixed voltage of ESWL. Group B patients received stepwise ramping voltage of ESWL. Group C patients received fixed maximal voltage with N-acetylcysteine (NAC) 600 mg/bid from 48 h before to 24 h after the procedure. Group D patients received gradual ramping voltage with NAC. Urinary β2-microglobulin, 24 h albumin and N-acetyl-β-d-glucosaminidase/creatinine ratio at 1 day and 5 days post-ESWL and the stone free rate at 2 weeks were measured.

Results

Group D was the only group that showed no significant difference pre and post ESWL in urinary albumin, β2-microglobulin and N-acetyl-β-d-glucosaminidase/creatinine ratio. Post hoc analysis revealed no significant difference between group B and group C in albumin, β2-microglobulin N-acetyl-β-d-glucosaminidase/creatinine ratio, but both of them had significantly lower levels than group A and significantly higher levels than group D. There was no statistically significant difference between all groups in the stone free rate at 2 weeks.

Conclusion

N-acetylcysteine protects the kidney against ESWL-induced renal injuries especially if combined with stepwise ramping voltage.

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Authors and Affiliations

  1. Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Esam A. E. Desoky, Ahmed M. Sakr, Mohamed Omran, Mohamed M. H. Abdalla, Ashraf S. Shahin & Maged M. Ali

  2. Urology Department, Faculty of Medicine, Benha University, Benha, Egypt

    Mohamed Alhefnawy

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  1. Esam A. E. Desoky
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  2. Ahmed M. Sakr
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Desoky, E.A.E., Sakr, A.M., Alhefnawy, M. et al. Renal protective effect of N-acetylcysteine with stepwise ramping voltage against extracorporeal shock wave lithotripsy-induced renal injury: a prospective randomized trial. Int Urol Nephrol 52, 2261–2267 (2020). https://doi.org/10.1007/s11255-020-02580-1

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