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High-power Ho:YAG lithotripsy increases subclinical renal stress: a prospective randomized KIM-1 study
Haider Nihad Izaddin Alalam1, Furkan Güldibi2, Mehmet Giray Sönmez2
1Urology Department, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey. hayderal-alim@hotmail.com.
Urolithiasis
|September 2, 2025
Summary
High-power lasers in kidney stone surgery show increased urinary injury biomarkers, indicating subclinical renal stress. However, overall kidney function remains unaffected post-procedure.
Area of Science:
- Urology
- Nephrology
- Biomedical Engineering
Background:
- Retrograde intrarenal surgery (RIRS) is a common treatment for kidney stones.
- Holmium:YAG (Ho:YAG) lasers are widely used for lithotripsy.
- Assessing laser power's impact on renal safety is crucial.
Purpose of the Study:
- To compare the safety profiles of high-power (HPL) and low-power (LPL) Ho:YAG lasers during RIRS.
- To evaluate urinary Kidney Injury Molecule-1 (KIM-1) as an early biomarker for acute kidney injury (AKI).
Main Methods:
- Prospective randomized study of 60 patients with renal stones (1.5-2.5 cm).
- Patients were assigned to HPL or LPL groups.
- Urinary KIM-1 and KIM-1/creatinine ratios measured preoperatively and postoperatively (4 and 24 hours).
- Assessed intraoperative parameters, stone-free rates (SFR), complications, renal function (eGFR, serum creatinine), and intrarenal temperatures.
Main Results:
- No significant differences in operative time, SFR, complications, or renal function (serum creatinine, eGFR) between groups.
- Significantly higher urinary KIM-1 levels and KIM-1/creatinine ratios observed in the HPL group at 24 hours postoperatively (p=0.003 and p=0.035, respectively).
- Slight, non-significant increase in intrarenal temperatures in the HPL group.
Conclusions:
- High-power laser lithotripsy in RIRS does not impair global renal function.
- HPL is associated with elevated urinary biomarkers of renal injury, suggesting potential subclinical renal stress.
- KIM-1 serves as a sensitive biomarker for detecting early renal stress following laser lithotripsy.
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