A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy-induced renal injury.
OBJECTIVE
To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury.


METHODS
A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion.


RESULTS
Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased.


CONCLUSIONS
Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction.
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Ahmed R
AR
El-Nahas
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Mohamed M
MM
Elsaadany
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Diaa-Eldin
DE
Taha
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Ahmed M
AM
Elshal
Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Mohamed Abo
MA
El-Ghar
Department of Clinical Pathology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Amani M
AM
Ismail
Department of Microbiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Essam A
EA
Elsawy
Department of Microbiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Hazem H
HH
Saleh
Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Ehab W
EW
Wafa
Department of Molecular Biology Laboratory, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Amira
A
Awadalla
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Tamer S
TS
Barakat
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Khaled Z
KZ
Sheir
D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008096:Lithotripsy / Q000009:adverse effects*; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D012643:Selenium / Q000627:therapeutic use*; D014700:Verapamil / Q000627:therapeutic use*; D014801:Vitamin A / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000517:prevention & control
D047228:Angiotensin II Type 1 Receptor Blockers; D000975:Antioxidants; D002121:Calcium Channel Blockers; D014815:Vitamins; D014801:Vitamin A; D014810:Vitamin E; D014700:Verapamil; D012643:Selenium; D019808:Losartan; D001205:Ascorbic Acid

MRI
; angiotensin receptor blockers; antioxidants; calcium channel blockers; extracorporeal shockwave lithotripsy; kidney stone