Mini-Percutaneous Nephrolithotomy Less Injurious to the Kidney?

Area of Science:

• Nephrology
• Urology
• Biomarker Research

Background:

• Percutaneous nephrolithotomy (PCNL) techniques are evolving towards smaller access sheaths, leading to various miniPCNL (mPCNL) systems.
• Urinary biomarkers like KIM-1, NGAL, and β2M are established noninvasive indicators of renal cellular injury.
• The study compares perioperative changes in urinary biomarkers across suction mPCNL (s-mPCNL), non-suction mPCNL (ns-mPCNL), and standard PCNL (sPCNL) systems.

Purpose of the Study:

• To evaluate and compare the changes in urinary biomarker levels (KIM-1, NGAL, β2M) in the perioperative setting.
• To assess the impact of different PCNL systems (s-mPCNL, ns-mPCNL, sPCNL) on renal cellular injury markers.

Main Methods:

• Three PCNL systems were used: s-mPCNL (18F), ns-mPCNL (17.5F), and sPCNL (24F).
• Urine samples were collected preoperatively (V1), 1 hour postoperatively (V2), and 10 days postoperatively (V3).
• Urinary biomarkers (KIM-1, NGAL, β2M) were measured using ELISA and normalized to urine creatinine.

Main Results:

• A statistically significant increase in NGAL levels was observed in both ns-mPCNL and s-mPCNL groups during the early postoperative interval (V1-V2).
• Urinary biomarker levels showed a significant decrease during the recovery interval (V2-V3) for all PCNL types.
• No significant differences in biomarker levels were found across all PCNL forms in the long-term injury interval (V1-V3).

Conclusions:

• A transient surge in urinary biomarkers occurs immediately after PCNL, indicating early tubular injury.
• This rise in biomarkers appears more pronounced with ns-mPCNL systems utilizing metal sheaths.
• The observed renal injury markers normalize within days, irrespective of the PCNL sheath size employed.