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La litotripsia de alta potencia de Ho:YAG aumenta el estrés renal subclínico: un estudio prospectivo aleatorizado de
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
Resumen
Los láseres de alta potencia en la cirugía de cálculos renales muestran un aumento de los biomarcadores de lesión urinaria, lo que indica estrés renal subclínico. Sin embargo, la función renal general no se ve afectada después del procedimiento.
Área de la Ciencia:
- Urología
- Nefrología
- Ingeniería biomédica
Sus antecedentes:
- La cirugía intrarenal retrógrada (RIRS) es un tratamiento común para los cálculos renales.
- Los láseres de holmio: YAG (Ho: YAG) son ampliamente utilizados para la litotripsia.
- Es crucial evaluar el impacto de la potencia del láser en la seguridad renal.
Objetivo del estudio:
- Comparar los perfiles de seguridad de los láseres Ho:YAG de alta potencia (HPL) y de baja potencia (LPL) durante el RIRS.
- Evaluar la molécula 1 de lesión renal urinaria (KIM-1) como un biomarcador temprano para la lesión renal aguda (AKI).
Principales métodos:
- Estudio aleatorizado prospectivo de 60 pacientes con cálculos renales de 1,5 a 2,5 cm.
- Los pacientes fueron asignados a grupos HPL o LPL.
- Las proporciones urinarias de KIM-1 y KIM-1/creatinina se midieron antes y después de la operación (4 y 24 horas).
- Se evaluaron los parámetros intraoperatorios, las tasas libres de cálculos (SFR), las complicaciones, la función renal (eGFR, creatinina sérica) y las temperaturas intrarenales.
Principales resultados:
- No hubo diferencias significativas en el tiempo operativo, el SFR, las complicaciones o la función renal (creatinina sérica, eGFR) entre los grupos.
- Se observaron niveles significativamente más altos de KIM-1 en orina y proporciones de KIM-1/creatinina en el grupo HPL a las 24 horas postoperatorias (p=0,003 y p=0,035, respectivamente).
- Aumento leve y no significativo de la temperatura intrarenal en el grupo HPL.
Conclusiones:
- La litotripsia láser de alta potencia en RIRS no perjudica la función renal global.
- La HPL está asociada con biomarcadores urinarios elevados de lesión renal, lo que sugiere un posible estrés renal subclínico.
- KIM-1 sirve como un biomarcador sensible para detectar el estrés renal temprano después de la litotripsia láser.
Palabras clave:
Laser de alta potenciaKIM-1 y sus derivadosPiedra en el riñónLaser de baja potenciaCirugía intrarenal retrógradaKIM-1 para el aparato urinarioMás Videos Relacionados
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